Required Information

How would you like to pay? Ödeme şekli . . . Banka EFT online $5 PTT Posta $3.50 Kargo UPS

NAME (First MI Last)

Mailing/Shipping Address
Address:
City: , State(TR): , Zip: , Country:

Daytime Telefon , E-mail:

I would prefer to be contacted by? How would you like to be contacted? day phone evening phone email

Fax # , Evening Telefon #:

Country code for Telefon: (if outside the Turkey)

Payment

Type of Card:
Visa MasterCard Amexpress Discover

Name as it appears on card:
Credit Card Number: , Expiration:(mmyy)

Please check here if you prefer that we call you for your credit card number or for other payment options.

All orders will be confirmed prior to shipping to ensure accuracy.
Orders will NOT be shipped without a valid telephone number and area code.

Comments or Special Instructions

How Did You Hear About Us?

Internet Pamphlet Ad in Classified Email Through a Friend
Postcard/letter Television Newspaper, City of Newspaper:
Keyword Search, Keyword used: Other

We Would Like To Get To Know You Better.

Your Your Age (in years): , Gender: select male female , Marital Status: Select single married divorced separated widowed

Current employment outside the home:

How many children do you have, if any? 0 1 2 3 4 5 6 7 8 9 10 , Their ages? (in years)

Are you looking for an Internet business to operate on a Part time or Full time basis? select part time full time

Or call your representative to place your order.
Your representative is: Jass