Date:_________________
Last Name:_____________________________________
First Name:_____________________________________
Current address:______________________________________
City/State:__________________________
Zip:__________________
Home phone:______________________________
Work Phone:_____________________________
IMPORTANT:$39.00 fee must be enclosed for processing. Our exclusive information service is not available in the state of Texas, Kansas, or Wisconsin.
We accept Money Orders and Personal Checks(Please allow 2 extra weeks to allow Personal Check to clear) Otherwise exspect you information in 4 to 6 weeks.