ORDER FORM

"Instant Web Profit System"

Please complete the form below and post it back to me at my address (shown at the bottom of this page)

Please Fill in your Information Below

Please charge my credit/debit card Amex / Visa / MasterCard / Switch / Solo / Delta / JCB the sum of £51.95 (i.e. £47 + £4.95 p&p)

Cardholder's Name (as it appears on the card):

_______________________________

Signature:

_______________________________

Expiry Date:

3 or 4 digit Security Code (on reverse of card above signature strip):

Valid From:

Card Issuer (eg. "Barclays" or "MBNA"): _____________________

Switch/Solo Issue No.:

OR

Please find enclosed my cheque/postal orders for £51.95 (i.e. £47 + £4.95 p&p) made payable to Wise Marketing UK Ltd.

Delivery Details

Date:

Mr/Ms/Mrs/Miss/Other:_______________________________

Name:_______________________________

Address:_______________________________

____________________________________

____________________________________

Postcode:___________________

Tel:________________________

Fax:________________________

e-mail:________________________________