Panhandle On=Line, Inc. Secure Order Form

Panhandle On-Line, Inc.
Secure Order Form

To activate your MILES (Multi-Party Indirect Link Exchange Service) subscription, complete the information below and proceed to our secure credit card server for payment. Your transaction will be confirmed by email.You are authorizing us to charge your card for $25.00 one time for an annual subscription. If you have problems with this form, you may contact us at Panhandle On-Line, Inc., P O Box 918, Marianna, Fl 32447. 850-526-5031

International signups are accepted. The "USA" in the country field below is for purposes of illustrating the format used.
MILES annual subscription ($ 25.00)

GENERAL INFORMATION

First Name: Last Name:

Address:

City: State: Zip:

Country:

Phone Number:

E-Mail Address:

First Name:	Last Name:
Address:
City:	State: Zip:
Country:
Phone Number:
E-Mail Address:

Panhandle On-Line, Inc. Secure Order Form

Panhandle On-Line, Inc.
Secure Order Form