9-11 DBCC Order and I800/E800 Listing Form

I. Customer Information: (All Fields Required)

 First Name: _____________________

 Last Name: ______________________

 Company Name:_____________________________________________________

 Company Address*: ___________________________________________________ 

 City: __________________________

 Phone*: __________________________

 State: _________________________

 Fax*: ____________________________

 Zip: ___________________________

 Email: ___________________________

 Country: ____________________

   * Indicate Company or Personal

   * Indicate Company or Personal 

II. Listing Information: (List Phone Number in DBCC I800/E800 Directory)

 Web Site URL: 

 Phone No. To be listed:

  1. http://________________________

  1.  ( ____ ) - _____- ______

  2. http://________________________

  2.  ( ____ ) - _____- ______

  3. http://________________________

  3.  ( ____ ) - _____- ______

International Calling Code:  ( _______ )

  Business Category to be listed in: 

     Main Category:________________ 

Sub Category:  ________________ 

III. . 9-11 DBCC Order Information:  (Please Note Cut Off Date for Low Price)
 

1.  Order prior to 9/2/02

     (Price Includes Sales Tax, Shipping Cost Extra, Domestic $3.95, International TBD)

2.  Order after 9/2/02

     Bulk Order Quantity: ____________________ $ Amount: ___________________

3.  Order for Single Copy accepted at the seminars or after 9/2/02 on Available Basis

4.  Send Order by email to info@ipo2u.com  

5.  Use On-line order form at www.mi-card.com/9-11dbcc/dbcc_order.html

6. Order Correspondence:

Name: ____________________________

Email: ____________________________

  Note: Email must be correct to receive confirmation and correspondence
           For On-Line Order, go to: www.mi-card.com/9-11dbcc/dbcc_order.html