4-1-1.com/info/coupons.htm
4-1-1.com/cohen/coupons.htm

			================================
			ORDER FORM - AUTHORIZATION #0102
			================================
Please Print This 
Form and Mail to: 	House of Coupons, Inc.
			P.O. Box 1150
			Clinton, WA  98236
			Authorization # 0102
			1-800-669-2149


Please indicate item desired and enclose Cashiers Check or Money Orders in
U.S. Dollars only, or you can now use MasterCard or Visa cards for purchases.

	

Enclosed is my:	[] Money Order/Cashiers Check (U.S. Dollars Only)

or, Charge my:  [] VISA  
		[] MasterCard




  __________________________________________________   ____/____
	    (enter your card number above)             exp. date


  __________________________________________________ 
	    (print name exactly as shown on card)


  __________________________________________________ 
	    (authorized signature)


  Address: ________________________________________________________

  City: ______________________ State: ______________  Zip: ________

	VISA & MasterCard Orders may be faxed to
	House of Coupons for quicker delivery at --  (360) 341-3475



Please select item(s) you wish to order:
----------------------------------------

[ ] ITEM #1: House of Coupons Prepaid Phone Cards 

					   1-5 Cards  6-10 Cards  11+ Cards
					   Price ea.  Price ea.   Price ea.
					   ---------  ----------  ---------
	Quantity: ______  30 Minute Card     $10.00     $ 7.50     $ 6.00

	Quantity: ______  60 Minute Card      15.00      10.25       9.05

	Quantity: ______ 100 Minute Card      25.00      15.65      13.65

	Quantity: ______ 120 Minute Card      30.00      18.25      15.95

	Quantity: ______ 200 Minute Card      40.00      28.95      25.15




[ ] $ 5.95 - ITEM #2: $1,000 Auto Discounts Book

[ ] $ 8.95 - ITEM #3: CAMTEC camera and KODAK film offer

[ ] $ 5.95 - ITEM #4: Air Checks

XXXXXXXXXX - ITEM #5: Cruise Discounts (OUT OF STOCK)

[ ] $ 5.95 - ITEM #6: Travel Directory, Car Rentals, Restaurants

[ ] $ 5.95 - ITEM #7: National Golfers Network

[ ] $ 5.95 - ITEM #8: Grocery Coupon Book


NOTICE  Please include an additional $5.50 with your order for the following items:

 	$2.50 - Activation, administration & handling
 	$3.00 - Shipping Charge by Priority Mail


						Thank You.