Use this form if paying by credit or debit card.
Please enter all information in the appropriate boxes below.
Note: We do not send separate confirmation of receipt of your order.
Your receipt from PayPal is confirmation that we received your order.
(PayPal can take up to 12 hours to forward your order & payment notification to us.)
Note: Annual Statements must be published each calendar year.
Please tell us the calendar year in which you would like your Statement published.
Upon publication a Certification of Publication will be sent to you by first class mail.
Please tell us where to send the Certification.
(The following information is not published.)