Payment/Authorization Information: Seminar

                              "What You Need to Know - Buying or Selling a Business" 

Accepted Payment Method: American Express, Discover, Master Card, Visa

Card Number :                  __________   __________   __________   __________

Expiration Date:                  __________ / __________  (MM/YY)

Amount:              $ ____________________ (i.e., $25.00)

_____________________________________________________________________________________

Order Information

                Invoice #:            ______________________________   Completed by Sunbelt

                Description:        ______________________________   Completed by Sunbelt

_____________________________________________________________________________________

Customer Billing Information

                Customer ID:     ______________________________   Completed by Sunbelt

                First Name:         ______________________________   (As appears on Credit Card)

                Last Name:         ______________________________   (As appears on Credit Card)

                Company:           ______________________________

                Address:              ______________________________

                Suite #:                 ______________________________

                City:                       ______________________________

                State:                    ______________________________

                Zip Code:             ______________________________

                Country:              ______________________________

                Phone:                 ______________________________

                Fax:                        ______________________________

                Email:                    ______________________________   (If you want a receipt)

Please return via fax to: 503-905-7600