ORDER FORM

Please provide the following contact information:

First name
Last name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Home Phone
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Please provide the following ordering information:

QTY	DESCRIPTION
	How To Achieve Quality of Life & Care in a Nursing Home - $14.95 + $3.00 Shipping and Handling = $17.95 per book
	Protecting Your Financial Security from Medical Catastrophe - $9.95 + $2.00 Shipping and Handling = $11.95 per book

Total amount of order:	$_____________

	SHIPPING
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Enter the date of ... :

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Payment is to be made by personal check or money order to FirstStep Marketing. Fill out this form, print it out and send to: FirstStep Marketing, 2348 N. Sterling Ave., #382, San Bernardino, CA 92404.  (If you don't have a printer, just write out the above information on a plain sheet of paper and mail it, with your payment, to the address above.)  Please allow 4 to 6 weeks for delivery.

Thank you for your order!  If you have any comments or questions, please email firststepmarket@worldnet.att.net .