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Order Form (for fax or mail only)

Fax this form to: 773-348-5991
Mail this form to: Immediate Fiction, 3540 N. Southport #341, Chicago, IL 60657


Date: _______________

Your Name: __________________________________________________

Your Street Address: ___________________________________________

City, State, Zip: _______________________________________________

Phone: _________________ Email: _______________________________

Check here if you are enrolling in time for the marketing consultation bonus: ____


Payment
To arrange payments, mail or fax in the information below or call me at 800-219-1114.

  • Credit Card (Visa, MasterCard, American Express):

    Card number: _________________________________________________

    Billing address if different from mailing address:

    _____________________________________________________________

    _____________________________________________________________

    Expiration date: _________ Signature: ____________________________

    Payment Option (check one):

    ____ One payment ($2,094).

    ____ Four (4) payments* ($523 each).

    ____ Five (5) Payments* ($418 each).

    ____ Six (6) Payments* ($349 each).

    *Please check to make sure your card doesn't expire before the last payment. Thanks.


  • Check or Money Order Payment (I'm only set up to take full payment this way.)

    Make check or money order payable to: Immediate Fiction.

    Send it to:
    Immediate Fiction
    3540 N. Southport #341
    Chicago, IL 60657.

    Your satisfaction is fully guaranteed. If you have questions, call and talk to me in person at 800-219-1114.