Order Form

(All orders processed within a single business day)

For your protection we will only mail member addresses to the billing address associated with your credit card.

If you would prefer to telephone, or fax your credit card details to us please see the bottom of this page.

If you wish, you can 'print' this form and fax it to us instead.

              First Name 
               Last Name 
         Bill to Address 
                         
                    City 
            State/County 
                Zip Code 
                 Country 
                   Phone 
                     Fax 
           Email Address 


             Credit card 
      Credit card number 
                Exp date 
         Cardholder name 
   Send my addresses via

Prices:

1 - 3 Member addresses for $25

4 - 8 Member addresses for $45

9 - 16 Member addresses for $65

Type in the member numbers of the members whose
addresses you wish to receive in the spaces provided below:

1	2	3	4
5	6	7	8
9	10	11	12
13	14	15	16

Total number of member addresses:
Charge my credit card $

Customers outside the United States using credit cards will be debited in American Dollars which are then converted to local currency
by the credit card company.


Luckyman
313 Creek Drive
Suite 114
St. Davids, PA  19087
USA

Tel: (610) 994-8196
FAX: (603) 947-9172
Email: info@luckyman.com