Home ~ • ~       ~ • ~       I   M   M   E   D   I   A   T   E       F   I   C   T   I   O   N       ~ • ~       ~ • ~ 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.