FAX

Circle order that applies

1. Direct Hit TM Search ($33 each)
2. Extensive Federal PLUS All 50 State TM Search ($99)
3. International Search ($200)
4. Common Law Search ($40)

Name(s) to be searched or registered- (Each name implies a charge)

1. _________________________
2. _________________________
3. _________________________
4. _________________________
5. _________________________

Name as it appears on credit card ____________________

Address as it appears on your billing statement.

Street ____________________________

City____________________________

State ___ Zip ____________

Visa - Mastercard - Amex  (circle one)

Card # ___________________________Exp. _________

E-mail address _________________________

Phone Number _________________________

Just print and fill out and fax to

800-887-9180