PERSONALIZED LEGENDS
ORDER FORM
Complete the form below to order your Personalized Legend. You are on a secure server. Your URL should read:

"https://www.bham.net/conwebsecure/legends/open.shtml"
If you are not at that page, then please call a/c 205, then 987 5315 and we will take your information over the phone.

Your Name: ( Exactly as it appears on your credit card - required field.)

YOUR E-mail Address: (required field.)

Street or PO Address on your Credit Card billing: (required field.)

City, State and Zip on your Credit Card billing: (required field.)

Phone: (required field.)

Type of Legend (required field.)

If "Other" above, please describe what type of legend you are looking for.


Bits of information that you want included in your legend. If you need additional space, or want to send an image or a source document, send a separate email.


Complete Card Number: (Visa -13 or 16 digits, Master Card -16 digits,. or American Express -15 digits. Card type will be determined from the card number, required field.)
(Use just numbers with no blanks, for example for 16 digit, input 4444333322221111, or use hyphens as delimiters, i.e. 4444-3333-2222-1111. Do not use spaces.)

Expiration Date: (format MM-YY, required field)


How did you connect with us:
  • Search Engine (Which One? What Key Words?),
  • Web Site (Which Site?),
  • Organizational Referral (Which organization?),
  • Word-of-Mouth (Please thank them!),
  • Other (Please Describe?).

(Folks, this is real important to anyone trying to offer service on the web, your response is valued very much.)



Yes, I am ordering a Personalized Legend. I am authorized to make charges against the credit card account listed above. You have my authorization to charge a $50.00 deposit against that account.(You must click "Yes" to proceed.)

Yes     No

Thank you very much. Please click the "Submit" button below when you are finished. The next step is a number of validation checks. Please be patient for a minute. You will have an opportunity to check the data before final submission.

Pete Smith
P.O. Box 361325
Birmingham, AL 35236
a/c 205

987 5315