PEOPLEFINDER ORDERFORM

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

To payby credit card, please attach a completed CreditCard authorization form to this PeopleFinder Order Form.

There is no charge for shippingor handling.

SHIPPING INFORMATION:

NAME: ____________________________________________________

COMPANY NAME: ___________________________________________

STREET ADDRESS:___________________________________________

CITY and STATE (PROVINCE):__________________________________

ZIP CODE (POSTAL CODE):____________________________________

( ) 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.

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 APPROPRIATEDISCOUNT(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.