iLeads Order Form

iLeads Order Form provided by Apparel Search

First Name:
Last Name:
Title:
Company:
Address:
City:
State:		Zip:
Country:
URL address:
E-mail address:
Phone:
Fax:

I would like to purchase the following items: (Choose any that apply)
buyers ILB101 ILB102 ILB103 ILB104 ILB111 ILB112 ILB113 ILB114 ILB121 ILB122 ILB123 ILB124 ILB125 ILB126 ILB127 ILB128 ILB129 ILB130 ILB131 ILB135	sales reps ILS501 ILS502 ILS503 ILS504 ILS505 ILS528 ILS529 ILS530 ILS531 ILS532 ILS550 ILS560	importers ILI301 ILI302 ILI303 ILI304 ILI305 ILI306 ILI320 ILI321 ILI322 ILI340 ILI341 ILI360 ILI380 ILI381 ILI382 editors ILE401 ILE402	designers ILD201 ILD202

Calculate your total purchase below. (ilead packages delivered via email)

Total: $285 x [# items] =

Total: $245 x [# items] =

Total: $195 x [# items] =

Total: $165 x [# items] =

Total: $135 x [# items] =

Select method of receiving data

email format: PC Mac No delivery fee

disc format: PC Mac $35 fee plus shipping and handling

hardcopy list: Yes $35 fee per package plus shipping and handling

Billing Information

eMail Bill: Amex: Mastercard: Visa:

Card Number: Exp:

Name on card:

special instructions or details

Do not forget to click the "Place Order" button above to transmit your order...

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