ASQDE 2008 AGM Exhibitor Online
Payment Form

Welcome Exhibitors!


From this page you may submit your deposit on-line by credit card (be sure to also download,
complete, and fax the Agreement (and the Level of Benefits form, if you plan to be a
Supporter or Sponsor) to Executive Assistant, Nanette Davis at (562) 901-3378).

NOTE:

    Please fill out the form in its entirety. If a field is not applicable or if the information
    is not available, please enter "n/a" in the appropriate field.

    You must enter a valid email address for your payment to be processed.

    Your order should be processed within 5 business days. If you have not received
    confirmation at that time, please contact Nanette Davis to confirm that your
    payment was received.


Full Name:
Agency or Company:
Address Line 1:
Address Line 2:
City:
State:
Postal or ZIP Code:
Country: 
Phone Number: 
Fax Number: 
Email:
   
Credit Card:
Name on Card:
Credit Card Number:
Expiration Date:
CVV2 Number:
Level of Support:
   I understand the balance is due August 1, 2008. I will pay as follows:
 

Mail Balance Payment to:

ASQDE
P.O. Box 18298
Long Beach, CA 90807

Note: If you have difficulties with this online form you may download and print the PDF version and mail it to the address above.