PEOPLEFINDER ORDER FORM

To purchase any PeopleFinder or Skiptrace CD-ROM product, please complete this order form, and return it to Pallorium, Inc. along with your check or money order.

To pay by credit card, please attach a completed Credit Card authorization form to this PeopleFinder Order Form.

There is no charge for shipping or handling.

SHIPPING INFORMATION:

NAME: ____________________________________________________

COMPANY NAME: ___________________________________________

STREET ADDRESS:___________________________________________

CITY and STATE (PROVINCE):__________________________________

ZIP CODE (POSTAL CODE):____________________________________

DAYTIME TELEPHONE NUMBER:________________________________

ELECTRONIC MAIL ADDRESS:______________________________

I HAVE ENCLOSED PAYMENT FOR THE FOLLOWING ITEMS :

PEOPLEFINDER CALIFORNIA 2002 (DVD); QUANTITY: _____________________ Price: ($499.00/set)

PEOPLEFINDER CALIFORNIA 2000 (DVD); QUANTITY: _____________________ Reduced Price: ($250.00/set)

PEOPLEFINDER WEST - ARIZONA (etc); QUANTITY: _______________________ Reduced Price: ($100.00/set*)

PEOPLEFINDER WEST - OREGON and WASHINGTON ; QUANTITY: ___________ Reduced Price: ($100.00/set*)

PEOPLEFINDER FLORIDA (1998-1999); QUANTITY: _______________________ Reduced Price: ($100.00/set)

PEOPLEFINDER TEXAS; QUANTITY: ___________________________________ Reduced Price: ($100.00/set)

PEOPLEFINDER GULF COAST; QUANTITY: ______________________________ Reduced Price: ($100.00/set)

PEOPLEFINDER TRI-STATE (NY/NJ/CT); QUANTITY: _____________________ Reduced Price: ($175.00/set)

PEOPLEFINDER NEW ENGLAND; QUANTITY: ___________________________ Reduced Price: ($100.00/set)

PEOPLEFINDER GREAT LAKES; QUANTITY: ____________________________ Reduced Price: ($100.00/set)

(*PEOPLEFINDER WEST - ARIZONA (etc) and PEOPLEFINDER WEST - OREGON and WASHINGTON are $75.00/set when purchased with any California PeopleFinder product. )

ARCHIVE CDs:

(LIMITED QUANTITIES AVAILABLE.)

PEOPLEFINDER WEST - CALIFORNIA (1998-1999); QUANTITY: _____________ Reduced Price: ($175.00/set)

PEOPLEFINDER CALIFORNIA (1997-1998); QUANTITY: ___________________ Reduced Price: ($99.00/set)

PEOPLEFINDER CALIFORNIA (1996-1997); QUANTITY: ___________________ Reduced Price: ($99.00/set)

SKIPTRACE NEW YORK (1996-1997); QUANTITY: ________________________ Reduced Price: ($99.00/set)

SKIPTRACE FLORIDA (1996); QUANTITY: ____________________________ __ Reduced Price: ($99.00/set)

SKIPTRACE TEXAS (1996-1997); QUANTITY: ___________________________ Reduced Price: ($99.00/set)

DISCOUNTS:

(PLEASE MARK THE APPROPRIATE DISCOUNT(S), IF ANY.)

( ) I HAVE ORDERED BETWEEN THREE (3) AND FIVE (5) SETS AT THE SAME TIME AND HAVE DEDUCTED TEN PERCENT (10%) FROM THE COST OF MY ORDER. ( ) I HAVE ORDERED MORE THAN FIVE (5) SETS AT THE SAME TIME AND HAVE DEDUCTED TWENTY PERCENT (20%) FROM THE COST OF MY ORDER. ( ) I AM A CURRENT SUBSCRIBER TO PALLTECH AND MY ACCOUNT IS IN GOOD STANDING. I HAVE DEDUCTED $25.00 FROM MY ORDER. ( ) I ALSO QUALIFY FOR THE FOLLOWING SPECIAL DISCOUNT(S): ___________________.

SUMMARY:

I HAVE ORDERED A TOTAL OF: ______________SETS OF PEOPLEFINDER AND/OR SKIPTRACE CD-ROM PRODUCTS.

 

PLEASE CHECK ONE:

( ) I AM ENCLOSING MY CHECK OR MONEY ORDER IN THE AMOUNT OF: $___________________.

( ) I AM PAYING BY CREDIT CARD AND HAVE ATTACHED A "CREDIT CARD AUTHORIZATION" FORM.