Coupon Spot
Secure Order Form

Select the option below that you would like to order. Your transaction will be confirmed by email. Once your transaction is complete you will be asked to fill out a form that will allow us to design your coupon. 

Select only one:
One county ($ 25.00)
Every county in one state ($ 45.00)
Every county in entire US ($ 99.00)

GENERAL INFORMATION
First Name: Last Name:
Address:
City: State: Zip:
County:
Phone Number:
E-Mail Address:


CHECKING ACCOUNT INFORMATION
At the bottom of your check is a series of numbers, separated by symbols. It is not necessary to enter symbols or spaces in the fields provided below.
Enter the series of nine numbers
between this symbol


Enter the series of numbers
found before this symbol
Check number to use:     (Not required.)
Note: Some banks use a non-standard format in this series of numbers. If your account number includes this symbol , simply disregard the symbols and enter this section of numbers.

CREDIT CARD INFORMATION
Card Number: Exp. Date:

Submit this form ONCE ONLY. Your transaction should be completed in 10-60 seconds, depending on Internet traffic. In some cases, it may take longer.