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| Name: _________________________ |
| Email: _________________________ |
| Company (optional): ______________
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| Address: _______________________ |
| City: ___________________________ |
| State: __________________________ |
| Country: ________________________ |
| Zip: ____________________________ |
| Phone: (_____) ______-
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( ) I am enclosing
a check or money order for $97 USD. Please note that we do not accept
checks by fax, so if you are paying by check or money order you must
mail it in to the address above.
Please make checks or money orders payable to the "Internet Marketing
Center." |
| ( ) I want to charge this purchase to my Credit Card
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