Celebrity Addresses Order Form

CONTACT-A-CELEBRITY
Secure Online Order Form
Please fill out the form below. When you are done, check for accuracy and be sure to click on the "Submit" button on the bottom of the form. If your browser cannot handle forms or if you have problems with this form, e-mail us your order at order department

Special Comments :
Please type into the box below, the items you want to order.

< Please Check THIS BOX to place your ORDER - .
"I want the secret link to the Celebrities Addresses Web Site so I can copy them.For this I agree to have you charge my Credit Card $10." It is agreed that upon payment approval that you will send me the secret web site with these addresses.
$10 < THEN... Check this button to confirm PRICE Charge:
Other Information:

Your Full Name:

Company Name:

E-mail Address (required):

Address:

City:

State:

Zip:

Country:

PAYMENT INFORMATION:
Payment Method: Credit Card Check MoneyOrder
Important: If you wish to send information via post office, Make payments payable to:
Celebrity Addresses
Celebrity Publications
P.O. Box 399, Lubec, ME. 04652 USA
and print out and mail this form with proper payment.
Fill out the credit card info below:

Credit Card Type:

Name on card:

Card Number:

Card Exp. Date: Month:--- Year:

Credit Card Authorization
(type 'I AGREE and amount'):

Additional Comments:
Where Did You Hear About Us?:
Search Engines (Enter Name)
Direct Email
Our Website (Enter URL:)
Print Advertising
Other

Double check your entries above. Then Click on the Submit Button.
Please note that in order for us to process your order, your e-mail address must be valid.

_COPYRIGHT _{TargetMan Agency
THANK
YOU FOR YOUR ORDER.}

Click your back button if you do not want to place an order yet.

Your Full Name:
Company Name:
E-mail Address (required):
Address:
City:
State:
Zip:
Country:

Credit Card Type:
Name on card:
Card Number:
Card Exp. Date:	Month:--- Year:
Credit Card Authorization (type 'I AGREE and amount'):