If you want to place an order online
(for investor leads
only) please fill in the form below.
Make sure to include your fax number. We will fax you an confirmation
before any order is processed.
Credit card number:
Expiration Date:
(Use format: 01/99)
Name as it appears on the card:
Billing Address:
City:
State: ZIP:
Organization:
Shipping Address:
City:
State: ZIP:
Work telephone number:
Home telephone number:
Fax number:
Delivery
Format:
Any delivery
format instructions:
Shipping method:
Your Shipping number:
Additional Shipping Instructions:
Email address:
Quantity of names wanted:
Please type in states wanted:
Any additional instructions or
comments:
Please push Submit button only once.
Thank you.
For more information please
email us at:
GLOBAL DIRECTListManagement,
Inc. 4200 S. Ocean Boulevard, Suite 101 - Palm Beach,
FL 33480
Tel. 561-586-8336 - Fax. 561-585-9469
