.
Check-By-Fax Order Form 
STEP # 1 : Use Your Browser's [ PRINT ] Button To Print This Page Now 

STEP # 2 : Complete The Following Information
 
Name : __________________________________ 

Address : ________________________________ 

City : ___________________________________ 

State : _______ Zip : ________________

 Enter Your Area Code + Phone Number : 

( _____ ) _____________________ 

Select One : 
( ___ ) $115 ($99 + $16 S&H Within USA) 
( ___ ) $120 ($99 + $21 S&H Outside USA)
STEP # 3: Enter Name Of Distributor Website
From Which You Are Placing This Order : ____________________________

bci

bci

STEP # 4: Fill out your check and attach here before faxing. Make sure account and routing
numbers (at the bottom portion of your check) are clearly visible. Make check payable to
Group AL Marketing.
IMPORTANT: (1) Make sure you SIGN your check, and (2) Make sure you write the
name of your Distributor's Website on the Memo portion of your check.

bci

bci

STEP # 5: Fax this Form to  +61-3-9455-3172

Attention : IPRO Distributor Website 1