You can order your lists right now on peel and stick labels, on disks or by email. Most orders will be shipped within 72 hours.

To order your list please choose the categories of your prospects above and complete the information below. After you
have completed this form you will be directed to a secured purchasing page, where you'll be able to make your payment by credit card or online check draft.

You may also send your order by regular postal mail, please print out this form and return with your payment payble to:

Avision Media
P.O. Box 6746
Albany, NY 12206

(518)986-2448

All information submitted in this form will be kept confidential and will not be given or resold to any other parties.

Please send my lists on: Labels   Disks   Email

 Name

Business Name 

 Address

City, State & Zip

 Country(if not in USA)

E-mail address

Payment Method: (complete this portion only if you are sending your payment by regular postal mail)
[]Check   []Money-Order  []Credit Card

Credit Cardholder Name:______________________________________________
Credit Card#: _______________________________________________________
Exp. Date: ________________________
Signature: ________________________________________________

Website Address

 Choose a category for your business.

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