Change Your Identity Order Form

SEND YOUR PAYMENT TO:

Discount Store
PO Box 241471
Milwaukee, WI 53224

You may also print this form and fax it to
305-946-3315

Please send me the Following format:

Create A New Identity In USA and Canada (Download) ($19.95)
Create A New Identity In USA and Canada (CD-ROM) ($22.95 Shipped)
How To Change Your Identity and Erase Bad Credit (Book) ($29.00 Shipped)
Special Offer How To Change Your Identity and Erase Bad Credit Book And Create New Identity CDROM ($39.95 Shipped)

Your Name:

Address Line 1

Address Line 2

City

State

Zip

Email address

Phone #

Please Check One:

Check / Money Order Enclosed

Charge It On My: Visa Mastercard

Credit Card Number Card Expiration

3 Digit Credit Card Verification Number
Listed on back of card, after card account number

Name as it appears on card


Cardholder Signature

I authorize "EZ Discount Store" to charge my credit card for
the "Change Your Identity" guide  for the amount as specified on my selection above 

(If ordering with credit card, this must be returned with card holders signature!)


Discount Store
PO Box 241471
Milwaukee, WI 53224
Fax: 305-946-3315