My Special Price Tonight Through Alex's Tele-Seminar Including All Bonuses is $497.00

For Credit Card Orders Via FAX or Mail

Please print this page and fill out the following information, then FAX to 512-335-6919

Your Name: __________________________________________________

Card Billing Address: __________________________________________

City: _____________________________ State: __________________ Zip: ________________

Country: __________________________________

Shipping Address ( if different ): ________________________________________________

City: _______________________ State: _______________________ Zip: ________________

Country: ____________________________________

Day Phone: __________________________ Eve. Phone: ________________________

Fax: _______________________ E-Mail: ________________________________

                                                                   Method of Payment
                                                          ( All Credit Cards Types Accepted )

Please Charge $ __________________

to card # _____________________________ Exp. ____________________

and $ _______________________

to card # _________________________________ Exp. __________________

for a total of $412.00 (including $15 shipping & handling).

Signature ( Required ) __________________________________ Date _____________