Important: Forms must be completed and faxed to us a minimum of 28 days prior to your 1st seminar date. 38 days for the West Coast. Upon receipt of this order form, we will provide your counts. Final count approval must be obtained prior to final production approval.

	C. Estimated Income: (20K increments)
	$ 30,000 -$49,999	$110,000 -$129,999
	$ 50,000 - $ 69,999	$ 130,000 - $149,999
	$ 70,000 -$ 89,999	$ 150,000 -$169,999
	$90,000 -$109,999	$170.000 Plus
	D. Additional Selects:
	Net worth 1.2 cents per name Presence of children 1 cent per name