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Successful Strategies Co.
 Mail-in Order Form

Print this page, fill it out and mail it to:
Successful Strategies
c/o Mailing Lists
6185 Magnolia Ave., Suite 358
Riverside, CA 92506

Please Rush Quantity ____________Names. From List___________________________________

or Other. Please Specify _______________________________________________________________

Enclosed is my payment $_______     ___Check  ___MoneyOrder  ___Visa   ___MasterCard  ___Discover ___Am Exp. 


FIRST NAME:________________________ LAST NAME: ______________________INITIAL: ________

STREET ADDRESS :___________________________________________________APT. NO. _______

CITY: __________________________________ STATE: __________ ZIP CODE: __________________

CREDIT CARD # _____________________________________________ EXP. DATE: _______/______

SIGNATURE:___________________________________________ PHONE: ______________________ 

Check one: __Peel and Stick ___Computer Paper __3.5" Disk for IBM or compatible __ASCII __dBase

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