Chance4U ORDER FORM 

Please, mail this form to address: Vladimir M. Tsygankov, mail box 138, Saint-Petersburg, 192241, Russia.

If you prefer to order using checks, international money orders or cash, your may insert it into letter with this order form at once.

Order 1-5 addresses and pay only $6.00 for each. Order 6-15 addresses and pay only $5.00 for each. Order more 15 addresses and pay only $4.00 for each. If you want your order delvered by ordinaly mail, please, add $1.5 for s$h per order.

Pay method (write Yes/Y, if necessary):
- checks, money orders or cash___,
- through webmoney___

Delivery method (write Yes/Y, if necessary):
- e-mail ____(free delivery)
- mail ___(please, add $1.5 for s$h per order)

Your Name:____________________________________________________________

Address:_____________________________________________________________

City:____________________________________ State: ____________________

Country:__________________________Postal Code:_______________________

Phone:___________________________________

Email address:__________________________________________________Date:______

Signature:______________________


Please, send me addresses of the following ladies:

#____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, #____, 


Total sum is $ ___________ (please, add $1.5 if you select mail delivery method) 

Thank you for your order!