Stey-Conn Order Form

newloop2.gif (7467 bytes) Order Form

$9.95
(Arizona Residents add $.76 sales tax $10.71 total)

Your Name:
Company:
Address: (Must Match credit card Billing address)
City
State/Province
Zip Code:


Email Address: (conformation will be emailed back)
Web Address: (Http://www.Your site.com)

Phone Number:
System ID:* (This number is shown on the startup screen)

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SELECT PRODUCT(S)

Stay-Conn $9.95

* We cannot process your order without this number

Credit Card Orders

Payment Information:

Credit Card:

Credit Card Number:

Expiration Date:

The Charge Will appear on your Credit card Statement as
Steve Karas and Associates

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Fax Order
To order by fax Print this order form and fax it to 602-494-9134

Mail Order
Print this order form and Mail it along with your check to
Steve Karas and Associates, 3341 E Turquoise, Phoenix, Az. 85028

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