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To Pay With American Express, Mastercard, or Visa

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You can give me your authorization and credit card information by phone at 800-634-5399...

or...

This is a  printable  form --
   if you wish, you can print it out, fill it in, and mail or fax it with your request for research.

Enter Total Amount of Charge: $_______________

Check Type of Account: AmEx_____ MC_____ Visa_____

Enter Charge / Credit Card Number:

Mastercard/Visa: __ __ __ __   __ __ __ __   __ __ __ __   __ __ __ __

Expiration Date: __ __ / __ __

Print Cardholder's Name (as on card): ____________________________________
Billing Address of Account:
_______________________________________________

_______________________________________________

Today's Date: ________________



_____________________________
Signature

If you wish, you can print out this form, fill it in, and mail or fax it with your request for research.

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