Mail Order Form

Mail Order Form

Please Print this Page. Then complete the printed form. If Rush Shipping is selected, please enclose an additional $15.00. We cannot accept orders from Maryland, South Dakota, North Dakota, or Wisconsin. Make your check or money order payable to A.D.P. Inc. Send a copy of the completed form with your payment to:

A.D.P. Inc.

685 E. I-10 Service Rd.

Slidell, LA 70461

Enclosed is $35.00 for The Homeworker's Directory w/ Free Mailing Program

I am enclosing an additional $7.00 for First Class Shipping.

I am enclosing an additional $15.00 for Rush Shipping.

Check**

Visa

Amex

Payment
Method

Money Order

Mastercard

Discover

Name:

__________________________________________

Today's Date:

______________

Address:

_______________________________________________________________________

City:

_____________________________

State:

_____________

Phone:

_____________________________

Zip:

_____________

Credit Card #:

_____________________________

Expiration Date:

_____________

Authorized Charge Amount/Amount Enclosed

:____________________________________________

Signature:

_______________________________________________________________

**For personal checks, please allow 20 days for bank clearance.

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