Prepaid Mail-In or Credit Card FAX Order Form

Prepaid Mail-In and Credit Card FAX Form

1. Please Print and Complete This Order Form.

2. Select Items You Wish to Order and Quantities Desired.

3. FAX This Form with Your Credit Card Information to: (908) 226-8715

...or Mail this Form with Your Check, Money Order or Credit Card Information ... to the address listed below:

USCCCNII/AMERICAN FOCUS
Post Office Box 663
South Plainfield, New Jersey 07080-0663
Fed. ID# 22-3248936

PRINT Name:_________________________________________________________________________________

Firm/Org/Agency/Inst:_________________________________________________________________________

Address:_____________________________________________________________________________________

City:____________________________________ State:___________________ Zip:________________________

Telephone: (_________) _______________________________ E-Mail:__________________________________ **LISTED PRICES INCLUDE D/C AND SHIPPING COSTS TO ALL USA DESTINATIONS.

QUANTITY................ITEM...........................................................SUBTOTAL...............TOTAL

_______ GANGSTA In The House - Audio Series and Book....$ 39.95 $_________________

_______ GANGSTA In The House - The Audio Series (Only)... $ 24.95 $_________________

_______ DEMYSTIFY Street Gangs - The Video Seminar .......$139.95 $_________________

_______ GANGS: Handbook For Community Awareness .......$ 39.95 $_________________

_______ The American Focus on Gangs - Series Volume 1 ...$ 95.00 $_________________

By Asbury Park New Jersey Police Director and CO3GA Founder L. Louis Jordan

Shipping via USPS Priority Mail or Best Way. Subtotal of Order:$________________________

**CHECKS/MONEY ORDERS Must Be Made Payable To: USCCCNII/AMERICAN FOCUS

NJ(Only) Purchasers Must Add 7% NJ Sales Tax: $________________ Exempt#:______________________

Total Including Sales Tax (NJ Only):$____________________________

Total of Check/Money Order Enclosed:$___________________________

****CREDIT CARD ORDERS:

Sub-Total of Ordered Items:$_______________________________

NJ (Only) Purchasers Must Add 7% NJS Tax $________________ Exempt#__________________________

Total Including Tax (NJ Only):$__________________________

Credit Card: ___Visa __Master Card __AMEX __Discover ....................Expiration Date:________/_______

Credit Card Number:_______________________________________________________Security Code:_________

Name on Card:_________________________________________________________________________________

Signature:_____________________________________________________________________________________

Be Sure To Click on the Links Below and Browse The Following Websites:

Bomb Countermeasures CD-ROM

A Career in Security Consulting and Much, Much More!

Proven-Effective Bullying Awareness, Intervention and Prevention Tools

Parents of Teenagers Resource Center - http://parents_of_teenagers.tripod.com/

IDENTIFYING LIES IN DISGUISE

If You Need a Blank Order Form - See:

http://uscccnii.tripod.com/credit_card_orders/id8.html