Profile Kingston - Current Issue Request Form

Issue requested:
__________________________________________
Quantity:
__________________________________________
First Name:

Last Name:
__________________________________________
Address:

City:

Province/State:

Postal/Zip Code:

Country:

E-mail (optional):
__________________________________________

VISA orders only:

Name of VISA card holder:_____________________

VISA account number:________________________

Expiry date:______________

Authorized signature:______________________

Date:___________________

__________________________________________

Current issue enquiries can be directed to:

Profile Kingston
P. O. Box 91
Kingston ON K7L 4V6

Telephone: (613) 546-6723 Fax: (613) 546-0707

Email:current@profilekingston.com

Profile Kingston and Summer in the City are divisions
of Riverview Publishing Inc.

© 2008 Profile Kingston/Summer in the City/Riverview Publishing Inc. No reproduction or republication in whole or part without written permission.