Transfer Money From Insurance to Your Account !!!

ORDER FORM - for Collecting Insurance in Full
Please print and RETURN this portion If printer does not print, or you don't have a printer, send your name, address and EMAIL ADDRESS (legibly) and mail to the address below. Send:
	or Money Order Or Cash - (USPS MO is considered cash and gives immediate delivery)

YOUR PERSONAL CHECK WELCOME !

Please Note: When ordering different topics ebooks you may use this SHOPPING CART APPLICATION .
For orders outside USA please send international Money Orders only payable through a USA Bank
Your co-operation is very appreciated

To:

Gold
P.O. Box 2202
Hollywood, CA 90078

If by using your information I cannot collect Insurance in Full every time, I am entitled to my money back.

Enclosed is $33 for Collecting Fully on Insurance Claims. (REf.erasebc.com)

Enclosed is $2 extra for priority handling.

Name
Address
City
State
ZIP Code
Area Code/Phone
E-mail
HOW DID YOU FIND US? (which search engine, keywords, etc.)