To order by FAX, print out this form, fill in completely and FAX to: (352) 754-2898

Name:___________________________________________________________

Shipping Address: __________________________________________________

City,State, Zip: ____________________________________________________

Daytime Phone: ____________________________________________________

Email Address (print clearly) : __________________________________________

Please check a box to select the desired software package:

Regulation D Package (covers 504,505 and 506 offerings) $495.00

Limited Liability Partnership Package $495.00

SCOR (Small Corporate Offering Registration) Package $495.00

For all three programs on CD-Rom Package $1250.00

Indicate your computer type: PC Macintosh

Please select delivery method:
3-day air (US Only) $14.00     Next-day air (US Only) $25.00
Outside US 2-5 days $35.00

Credit Card Information:       Card Type: VISA Master Card AMEX

Name on card: _______________________________________________

Billing address for card: ________________________________________

_________________________________________

Credit Card #: ________________________________ Exp. Date: ________

Cardholder Signature: ______________________________ Date: ________
I hereby authorize charging the above indicated product and shipping charges.