FAX or MAIL
SUBSCRIPTION/MEMBERSHIP FORM

Print this page, fill out and FAX it to Two-Cylinder® at (319) 824-2662
or mail to Two-Cylinder, PO Box 430, Grundy Center, IA 50638

Please print clearly:

Name:_________________________________________________
Street Address:__________________________________________
City:____________________________________________ State:______ Zip:__________________
Phone (if we have a question about your order):___________________________________________

RATES

United States

____ 1-Year Subscription $40.00

If Priority mailing is desired, please add
$24.00 per year

Canada

____ 1-Year Basic Subscription $56.95

If Priority Mail is desired, please add 
$30.00 per year

 

If this Two-Cylinder subscription / membership is being sponsored by a current member, please note that member's name below for our records.

_____________________________________

Foreign

____ 1-Year Subscription $94.95

If Air Mail is desired, please add 
$35.00 per year

 

Is this a gift subscription/membership for the person named above? If so, enter your name and address here and we'll send a gift card in your behalf.

________________________________

________________________________

_________________________________

 

PAYMENT INFORMATION:

_____Check or ______Money Order (U.S. Funds) Enclosed
_____VISA ______Mastercard

Account Number:___________________________________

Expiration Date:___________________________________

Signature Required for Credit Card Orders:

_______________________________________________

 

© Two-Cylinder® Club