ORDER FORM Please print this form out, fill in, and send to us with at least 100 business cards, your client list with complete information, (name and address, date of transaction, and type; ex. buyer, seller, refi, etc.), and payment. A minimum of 10 enrollments required. One-time sign-up fee $25 Send to Success Concepts Online /PO Box 480162/Denver, CO 80248 . Phone : 1-877-425-0100. Fax : (720) 945-0423. E-Mail : sales@successconceptsonline.com .

Todays Date:  Your Birthday:  Your Name:  Sign name as:  Office:  Phone #:  Address:  E-mail:    Fax #: CHECK ONE ____10 card program (Realtor) $39.50 ____10 card program (Mortgage) $39.50 ____10 card program (Sales Professional) $39.50 ____Custom program $ _______ #cards____ #years____   Do you require your local postmark? Yes ___No___(If yes, for an additional $2 per client enrolled we will ship the finished cards to you, for you to put in the mail locally) What month would you like us to begin contacting you for your previous month's transaction information?__________ How did you find out about our Website?______________________ Preferred method of payment:Check (attached)___ Amex___Visa___M/C___Discover___ Credit Card #:_________________________________ Exp. Date:___________ Credit Card Billing Address:__________________________________________ Number of enrollments submitted_______ @$__________each =____________ Total Amount Due $_______________