1. Describe the service(s) you would like to order, (for 6 months or 1 year term):
	2. Name to accept mail under: 3. Mail forward frequency (daily, weekly, monthly, etc): 4. Name to forward mail to you: 5. Address: 6. City & Postal Code: 7. Country: 8. Phone: 9. If ordering voice mail/fax line, what email would you like them to go to? 10. If ordering a call forward line, what number do you need calls diverted to? 11. Special Instructions: 12. Payment Method: Tick below for your preferred method of remittance: Once we receive your completed order form we'll email you the remittance details.
	Western Union   Bank Wire   E-gold   E-bullion    Moneybookers   Web Money
	13. How did you hear about us? 14. E-mail address: Please INCLUDE your e-mail address to contact you regarding this order. Thank you