Print this order form to order by Fax or mail

"Work at home resource e-directory"

You must include an e-mail address. 
The e-Directory can only be sent via e-mail
Deliverable E-Mail Address:
Name:
Address:
City:
 State:
Zip:
Phone Number:		 _____________________________
_____________________________
_____________________________
_____________________________
_____________________________
____________________
____________________  

Visa/MasterCard/American Express:
Charge $39.95  to my Credit Card.
 MC     VISA       AMEX       Discover
Card Number:
Exact Name on Card:
  Expiration Date:
Billing Address:
  Billing City,ST,Zip: 		 ____________________________
____________________________
____________________________
____________________________
____________________________


OR
 Pay by Check
Debit my checking account, one time only, in the amount of $39.95.
Bank Name:
Bank Address:
All  Numbers At The Bottom Of Your Check:
Check Number:
State and Drivers License Number: 		___________________________
___________________________
___________________________
___________________________
___________________________
___________________________

 
 

SEND BY MAIL TO:
Internet Achievers -  2600 SE Ocean Blvd. # F-5 - Stuart, FL 34996

Enclose check, money order, cashiers check or 
credit card information when sending order by mail.
OR
BACK TO ORDERING ONLINE