If you are paying online with a credit card, this Mail/Fax Order form is not required.

Complete and send this page only if you are doing any of the following:
1. Postal Mailing Check or Money Order
2. Faxing or Postal Mailing Purchase Order
3. Faxing or Postal Mailing Credit Card Payment Info

We cannot activate your account until we receive this form. 
In addition, you must register online to manage your account.

Mail check or money order (U.S.$) payable to: GraduateNurse.com, Inc. 
280 Worcester Road, Suite 205 
Framingham, MA 01702 USA

Please Print: 

Company ____________________________________________________ 

Address _____________________________________________________ 

City, State, Zip, Country ________________________________________________ 

Phone Number _______________________  Fax _____________________ E-Mail ______________________

Select GraduateNurse.com Pricing Plan (Check or Circle): 
 
[ ]  Single Post (up to 45 consecutive days) $45 [1 Position]
[ ]  45 Day Unlimited Job Subscription $145 [Multiple Ads]
[ ]  1 Year Unlimited Job Subscription $1295 [Multiple Ads]
[ ]  Directory Listing- 1 Year Basic $95 
[ ]  Directory Listing- 1 Year Detailed $125 
[ ]  Banner Ad- Main Page (Per Month) $300 
[ ]  Banner Ad- Off Main (Per Month) $250 

Method of Payment

MasterCard ___ Visa ___ Check/Money Order ___ Card #: _________________________________________

Name on Card: __________________________________ Expiration Date: __________ (mmyy)

Signature: _________________________________  Date: _______________ 

Print Name:_____________________________________

By endorsing this form, I agree to comply with the GraduateNurse.com Service Agreement, 
and understand payment for the above selected pricing plan, is due upon receipt 
of electronic or mailed invoice. I authorize GraduateNurse.com, Inc. to use 
the information I provide here to charge my credit card(if selected as payment choice)
for services rendered.