
<HTML> 
<SCRIPT SRC=mainscr.js></SCRIPT> 
<SCRIPT src=mainlib.js></SCRIPT> 
<SCRIPT language=JavaScript> 
<!--
ll11liilIlllil(); // --> </SCRIPT> 
<HEAD>
<TITLE>Order Form</TITLE> </HEAD> 
<BODY onLoad="javascript:lIi1ll1111IiIi(document.forms[0]);"> 
<center> 
<br> 
<form method=POST action="" name=Form1 onSubmit="javascript:if (!liI1IliI1I1lI1ilIlii(document.forms[0])) return false;"> 
<!-- 
<input type=hidden name=toscreen value=false> 
<input type=hidden name=verify value=false> 
<input type=hidden name=required value=false> --> 
<input type=hidden name=notifyaddress value=""> 
<input type=hidden name=thank_you value=""> 
<input type=hidden name=ProgramCode value=""> 
<input type=hidden name=TrackingCode value=""> 
<input type=hidden name=AffiliateCode value=""> 
<input type=hidden name=EnvUrl value=""> 
<input type=hidden name=EnvReferrer value=""> 
<input type=hidden name=EnvAgent value=""> 
<input type=hidden name=EnvSys value=""> 
<input type=hidden name=EnvPlug value=""> 
<input type=hidden name=RejInfo value=""> 
<!-- shopping cart, see variable IlIiiiIli11 = 5 --> 
<INPUT type=hidden name=Item1SKUNum value=""> 
<INPUT type=hidden name=Item1Desc value=""> 
<INPUT type=hidden name=Item1UnitPrice value=""> 
<INPUT type=hidden name=Item1Qty value=""> 
<INPUT type=hidden name=Item2SKUNum value=""> 
<INPUT type=hidden name=Item2Desc value=""> 
<INPUT type=hidden name=Item2UnitPrice value=""> 
<INPUT type=hidden name=Item2Qty value=""> 
<INPUT type=hidden name=Item3SKUNum value=""> 
<INPUT type=hidden name=Item3Desc value=""> 
<INPUT type=hidden name=Item3UnitPrice value=""> 
<INPUT type=hidden name=Item3Qty value=""> 
<INPUT type=hidden name=Item4SKUNum value=""> 
<INPUT type=hidden name=Item4Desc value=""> 
<INPUT type=hidden name=Item4UnitPrice value=""> 
<INPUT type=hidden name=Item4Qty value=""> 
<INPUT type=hidden name=Item5SKUNum value=""> 
<INPUT type=hidden name=Item5Desc value=""> 
<INPUT type=hidden name=Item5UnitPrice value=""> 
<INPUT type=hidden name=Item5Qty value=""> 
<table border=0 cellpadding=0 cellspacing=0 width=580> 
<tr> 
<td width=100%> 
<b>
<font face="Verdana, Arial, Helvetica" size=5 color=#006699>
<img border=0 src=http://home.earthlink.net/~ad61/cologo.gif align=right width=156 height=45>Secure Order Form
<br>for Instant Processing</font></b> 
<br> 
<br> </td> </tr> 
<tr> 
<td width=100% bgcolor=#E7E7CE> 
<b>
<font face="Verdana, Arial, Helvetica" size=4>Step 1: Review for accuracy of your order</font></b></td> </tr> 
<tr> 
<td width=100% height=10> </td> </tr> 
<tr> 
<td width=100%> 
<table border=0 cellpadding=0 cellspacing=0 width=100%> 
<tr> 
<td valign=top width=53% bgcolor=#006699>
<b>
<font size=2 color=#FFFFFF face="Verdana, Arial, Helvetica">Item</font></b></td> 
<td valign=top width=13% bgcolor=#006699 align=right>
<b>
<font size=2 color=#FFFFFF face="Verdana, Arial, Helvetica">Quantity</font></b></td> 
<td valign=top width=18% bgcolor=#006699 align=right>
<b>
<font size=2 color=#FFFFFF face="Verdana, Arial, Helvetica">Unit Price</font></b></td> 
<td valign=top width=16% bgcolor=#006699 align=right>
<b>
<font size=2 color=#FFFFFF face="Verdana, Arial, Helvetica">Subtotal</font></b></td> </tr> 
<tr> 
<td valign=top width=53%> 
<b>
<font size=2 face="Verdana, Arial, Helvetica"> 
<SCRIPT language=JavaScript> 
<!--
document.write(IlIilIIiliiI[IiIiiliiii111i()]); // --> </SCRIPT> </font></b> </td> 
<td valign=top width=13% align=right> 
<b>
<font size=2 face="Verdana, Arial, Helvetica"> 
<SCRIPT language=JavaScript> 
<!--
document.write(IlIilIIiliiI[Iii1IIi1lIlIiI()]); // --> </SCRIPT> </font></b> </td> 
<td valign=top width=18% align=right> 
<b>
<font size=2 face="Verdana, Arial, Helvetica"> 
<SCRIPT language=JavaScript> 
<!--
document.write(liiIiIlI1iiiiilii(IlIilIIiliiI[II1Iliiilii()])); // --> </SCRIPT> </font></b> </td> 
<td valign=top width=16% align=right> 
<b>
<font size=2 face="Verdana, Arial, Helvetica"> 
<SCRIPT language=JavaScript> 
<!--
document.write(liiIiIlI1iiiiilii(IlIilIIiliiI[II1Iliiilii()] * IlIilIIiliiI[Iii1IIi1lIlIiI()])); // --> </SCRIPT> </td> </tr> 
<tr> 
<td valign=top width=84% colspan=3 align=right bgcolor=#006699>&nbsp;</td> 
<td valign=top width=16% bgcolor=#006699 align=right>&nbsp;</td> </tr> 
<tr> 
<td valign=top width=84% colspan=3 align=right>
<font size=2 face="Verdana, Arial, Helvetica">Shipping &amp; Handling:</font></td> 
<td valign=top width=16% align=right> 
<b>
<font size=2 face="Verdana, Arial, Helvetica"> 
<SCRIPT language=JavaScript> 
<!--
document.write(liiIiIlI1iiiiilii(IlIilIIiliiI[lii111II111l()])); // --> </SCRIPT> </font></b> </td> </tr> 
<tr> 
<td valign=top width=84% colspan=3 align=right>
<font size=2 face="Verdana, Arial, Helvetica">Sales Tax 
<SCRIPT language=JavaScript> 
<!--
document.write(l1I11IliIiIIII1()); // --> </SCRIPT> %:</font></td> 
<td valign=top width=16% align=right> 
<b>
<font size=2 face="Verdana, Arial, Helvetica"> 
<SCRIPT language=JavaScript> 
<!--
document.write(liiIiIlI1iiiiilii(l111IiIi1lilIil1ll())); // --> </SCRIPT> </font></b> </td> </tr> 
<tr> 
<td valign=top width=84% colspan=3 align=right bgcolor=#006699>
<b>
<font face="Verdana, Arial, Helvetica" size=2 color=#FFFFFF>Total Amount:</font></b></td> 
<td valign=top width=16% bgcolor=#006699 align=right> 
<b>
<font size=2 face="Verdana, Arial, Helvetica" color=#ffffff> 
<SCRIPT language=JavaScript> 
<!--
document.write(liiIiIlI1iiiiilii(li1lIl1Ii1IllIl())); // --> </SCRIPT> </font></b> </td> </tr> 
<tr> 
<td colspan=4>
<font face="Verdana, Arial, Helvetica" size=2>
<br>To make corrections and return to the previous page, 
<a href="javascript:history.back();">click here.</a> If the above is correct, proceed with step 2 below.</font></td> </tr> </table> </td> </tr> 
<tr> 
<td width=100% height=10> </td> </tr> 
<tr> 
<td width=100% bgcolor=#E7E7CE> 
<p>
<b>
<font face="Verdana, Arial, Helvetica" size=4>Step 2: Enter your e-mail &amp; delivery address</font></b></td> </tr> 
<tr> 
<td width=100% height=10> </td> </tr> 
<tr> 
<td width=100%> 
<font face="Verdana, Arial, Helvetica" size=2>
<b>Note:</b> Fields marked with 
<font color=red size=+1>
<b>*</b></font> are required and cannot be left blank.</font> </td> </tr> 
<tr> 
<td width=100% height=10> </td> </tr> 
<tr> 
<td width=100%> 
<table border=0 cellpadding=0 cellspacing=0 width=100%> 
<tr> 
<TD width=50% align=right>
<font size=2 face="Verdana, Arial, Helvetica">Your Email Address:&nbsp;</font></TD> 
<TD width=50%>
<INPUT maxLength=100 size=20 name=Email onFocus="javascript:Il1iI1i1II1I1I111l(Ii1lIiil1iIll1Il1II1);" onChange="javascript:Ii11illII1iiI(this);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr>
<tr> 
<TD width=50% align=right>
<font size=2 face="Verdana, Arial, Helvetica">Re-Type Email Address:&nbsp;
<br> 
<small>
<font color=#666666>(to prevent typos)&nbsp;</font>
<br></small></font></TD> 
<TD width=50%>
<INPUT maxLength=100 size=20 name=EmailMatch onFocus="javascript:Il1iI1i1II1I1I111l(Ii1lIiil1iIll1Il1II1);" onChange="javascript:IiiIIIiliI1illi(this.form[IllI1lIiIiI1()], this);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr> </table> </tr> 
<tr> 
<td width=100% height=10> </td> </tr> 
<tr> 
<td width=100%> 
<table border=0 cellpadding=0 cellspacing=0 width=100%> 
<tr> 
<TD width=50% align=right>
<FONT size=2 face="Verdana, Arial, Helvetica">Delivery Country:&nbsp;</FONT></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=Country value=USA onFocus="javascript:Il1iI1i1II1I1I111l(II1li1IiI1Iii1);" onChange="javascript:I1lIIli1ilII11(this, I11i1lIl1I1i1ii1); l1IIl11l1iiIiIil1(this.form);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr> </table> </tr> 
<tr> 
<td width=100% height=10> </td> </tr> 
<tr> 
<td width=100%> 
<table border=0 cellpadding=0 cellspacing=0 width=100%> 
<tr> 
<TD width=50% align=right>
<FONT size=2 face="Verdana, Arial, Helvetica">First Name:&nbsp;</FONT></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=FirstName onFocus="javascript:Il1iI1i1II1I1I111l(lIilI1li1lliiIll, l1iI1ilIi11II);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr> 
<tr> 
<TD width=50% align=right>
<FONT size=2 face="Verdana, Arial, Helvetica">Last Name:&nbsp;</FONT></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=LastName onFocus="javascript:Il1iI1i1II1I1I111l(Iillil1I1lIIiI1lI, Iiilll1ili1IIIiIiI1);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr> 
<tr> 
<TD width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>Organization (if any):&nbsp;</font></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=Organization onFocus="javascript:Il1iI1i1II1I1I111l(I1liiIIIl11liil1I1);"></font></TD> </tr> 
<tr> 
<TD width=50% align=right>
<FONT size=2 face="Verdana, Arial, Helvetica">Address:&nbsp;</FONT></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=Address1 onFocus="javascript:Il1iI1i1II1I1I111l(Illii1liIiIII1I11);">
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>
<b>*</b></font></b></font></TD> </tr> 
<tr> 
<TD width=50% align=right>
<FONT size=2 face="Verdana, Arial, Helvetica">City:&nbsp;</FONT></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=City onFocus="javascript:Il1iI1i1II1I1I111l(lIIl1IIllili);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr> 
<tr> 
<TD width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>State or Province:&nbsp;</font></TD> 
<TD width=50%>
<INPUT maxLength=10 size=20 name=StateOrProvince onFocus="javascript:Il1iI1i1II1I1I111l(IlI11liI1llll1Ii, IiIl1IIlI1iII1I11i1l);" onChange="javascript:l1I1iIiilllIIil1(this);"></TD> </tr> 
<tr> 
<TD width=50% align=right>
<FONT size=2 face="Verdana, Arial, Helvetica">Zip or Postal Code:&nbsp;</FONT></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=ZipOrPostalCode onFocus="javascript:Il1iI1i1II1I1I111l(lI1IiIiII1iI, I1IIllllIi1iI);" onChange="javascript:I1i1iIIi1l1iiI1il(this);"></font>
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr> 
<tr> 
<TD width=50% align=right>
<FONT size=2 face="Verdana, Arial, Helvetica">Your Phone Number:
<br>
<font size=1 color=red>(as on file with your credit card or bank)&nbsp;
<br></FONT></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=Phone onFocus="javascript:Il1iI1i1II1I1I111l(I1II11IIll1i1I1, liIiiiIIlIl11i1iIIII);" onChange="javascript:llIl1iI11llii1i1l1i(this);"></font>
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></TD> </tr> </table> </td> </tr> 
<tr> 
<td width=100% height=15> </td> </tr> 
<tr> 
<td width=100% bgcolor=#E7E7CE>
<b>
<font face="Verdana, Arial, Helvetica" size=4>Step 3: Choose your payment method</font></b></td> </tr> 
<tr> 
<td width=100%> 
<table border=0 cellpadding=0 cellspacing=0 width=100% height=50> 
<tr> 
<td width=100% height=10 colspan=10></td> </tr> 
<tr> 
<td width=3% height=29>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<input type=radio value=VISA name=PayMethName checked onClick="javascript:Ii1I1iiIli11ili(this.form);"></font></b></td> 
<td width=17% height=29 valign=top>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<a href="javascript:document.forms[0][IIliIliI1ii1111I11l()][0].click();">
<img border=0 src=http://home.earthlink.net/~ad61/paymeth_visa.gif width=48 height=31></a>
<br> VISA</font></b></td> 
<td width=3% height=29>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<input type=radio value=MC name=PayMethName onClick="javascript:Ii1I1iiIli11ili(this.form);"></font></b></td> 
<td width=17% height=29 valign=top>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<a href="javascript:document.forms[0][IIliIliI1ii1111I11l()][1].click();">
<img border=0 src=http://home.earthlink.net/~ad61/paymeth_mc.gif width=50 height=31></a>
<br> MasterCard</font></b></td> 
<td width=3% height=29>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<input type=radio value=AMEX name=PayMethName onClick="javascript:Ii1I1iiIli11ili(this.form);"></font></b></td> 
<td width=17% height=29 valign=top>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<a href="javascript:document.forms[0][IIliIliI1ii1111I11l()][2].click();">
<img border=0 src=http://home.earthlink.net/~ad61/paymeth_amex.gif width=48 height=31></a>
<br> American Express</font></b></td> 
<td width=4% height=29>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<input type=radio value=Discover name=PayMethName onClick="javascript:Ii1I1iiIli11ili(this.form);"></font></b></td> 
<td width=16% height=29 valign=top>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<a href="javascript:document.forms[0][IIliIliI1ii1111I11l()][3].click();">
<img border=0 src=http://home.earthlink.net/~ad61/paymeth_discover.gif width=50 height=31></a>
<br> Discover</font></b></td> 
<td width=4% height=29>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<input type=radio value=Echeck name=PayMethName onClick="javascript:Ii1I1iiIli11ili(this.form);"></font></b></td> 
<td width=16% height=29 valign=top>
<b>
<font face="Verdana, Arial, Helvetica" size=1>
<a href="javascript:document.forms[0][IIliIliI1ii1111I11l()][4].click();">
<img border=0 src=http://home.earthlink.net/~ad61/paymeth_echeck.gif width=50 height=31></a>
<br> U.S. Checking Account</font></b></td> </tr> 
<tr> 
<td width=100% height=10 colspan=10></td> </tr> </table> </td> </tr> 
<tr> 
<td width=100% bgcolor=#E7E7CE>
<b>
<font face="Verdana, Arial, Helvetica" size=4>Step 4: If you chose a credit card, enter the details here:&nbsp;</font></b></td> </tr> 
<tr> 
<td width=100%> 
<table border=0 cellpadding=0 cellspacing=0 width=100%> 
<tr> 
<td width=100% height=10 colspan=2></td> </tr> 
<tr> 
<td width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>Credit Card Number:&nbsp;</font></td> 
<td width=50%>
<INPUT maxLength=50 size=20 name=CCNumber onFocus="javascript:Il1iI1i1II1I1I111l(I11IiII11IllIliIil1i);" onChange="javascript:l11IiiI1il1(this.form.elements[IIliIliI1ii1111I11l()], this);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></td> </tr> 
<tr> 
<td width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>Expiration Month:&nbsp;</font></td> 
<td width=50%>
<INPUT maxlength=2 TYPE=text NAME=CCExpiresMonth SIZE=2 onFocus="javascript:Il1iI1i1II1I1I111l(I1iI1Il1iIllIi);" onChange="javascript:IIIIililIil1il(this);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b> 
<font size=2 face="Verdana, Arial, Helvetica">&nbsp;Year:&nbsp;</font>
<font size=3>
<INPUT maxlength=4 TYPE=text NAME=CCExpiresYear SIZE=4 onFocus="javascript:Il1iI1i1II1I1I111l(I1iiilI1ii1l1i1);" onChange="javascript:IIl1IIl1lllII11I(this);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></td> </tr> 
<tr> 
<td width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>Your Name, Exactly as Printed On Card:&nbsp;</font></td> 
<td width=50%>
<INPUT maxLength=50 size=20 name=CCNameOnCard onFocus="javascript:Il1iI1i1II1I1I111l(Ii1iilii11I1iliII);" onChange="javascript:I1lIIli1ilII11(this, I1Ii1II1liillIllii);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></td> </tr> 
<tr> 
<td width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>Credit Card Holder's Billing Address:
<br> 
<small>
<font color=red>(where 
<b>you</b> receive your monthly statements)&nbsp;
<br></font></small></font></td> 
<td width=50%>
<INPUT maxLength=50 size=20 name=CCBillingAddress onFocus="javascript:Il1iI1i1II1I1I111l(llIliil1liI1llIllii);" onChange="javascript:I1lIIli1ilII11(this, Illii1liIiIII1I11);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></td> </tr> 
<tr> 
<td width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>Billing City:&nbsp;</font></td> 
<td width=50%>
<INPUT maxLength=50 size=20 name=CCBillingCity onFocus="javascript:Il1iI1i1II1I1I111l(lIIiIIllli1lii);" onChange="javascript:I1lIIli1ilII11(this, lIIl1IIllili);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></td> </tr> 
<tr> 
<TD width=50% align=right>
<font face="Verdana, Arial, Helvetica" size=2>Billing State or Province:&nbsp;</font></TD> 
<TD width=50%>
<INPUT maxLength=10 size=20 name=CCBillingStateOrProvince onFocus="javascript:Il1iI1i1II1I1I111l(I11lii1l1l1iiil, IiII1I1ii1lilIl1Il);" onChange="javascript:l1I1iIiilllIIil1(this);"></TD> </tr> 
<tr> 
<TD width=50% align=right>
<font size=2 face="Verdana, Arial, Helvetica">Billing Zip or Postal Code:&nbsp;</font></TD> 
<TD width=50%>
<INPUT maxLength=50 size=20 name=CCBillingZipOrPostalCode onFocus="javascript:Il1iI1i1II1I1I111l(liIl11l1IIi1IlIi, lIl1lIliiiII1lIil11);" onChange="javascript:I1i1iIIi1l1iiI1il(this);">
<b>
<font color=#FF0000 face="Verdana, Arial, Helvetica" size=4>*</font></b></font></TD> </tr> 
<tr> 
<TD colspan=2>
<font size=1 face="Verdana, Arial, Helvetica" color=red>&nbsp;
<br> 
<img border=0 src=http://home.earthlink.net/~ad61/bulletred.gif width=5 height=5> Enter the address where 
<b>YOU</b> receive your monthly card statements. (typically your home address)
<br>
<img border=0 src=http://home.earthlink.net/~ad61/bulletred.gif width=5 height=5> For each order, we verify that this address matches what the bank has on file for you. 
<br>
<img border=0 src=http://home.earthlink.net/~ad61/bulletred.gif width=5 height=5> If there's a mismatch, your order may be delayed or completely rejected.
<br> 
<img border=0 src=http://home.earthlink.net/~ad61/bulletred.gif width=5 height=5> Do 
<u>
<b>NOT</b></u> enter the corporate address of your credit card issuing bank--enter 
<b>YOUR</B> billing address! :-)
<br></font> </table> </td> </tr> 
<tr> 
<td width=100% height=15></td> </tr> 
<tr> 
<td width=100% bgcolor=#E7E7CE>
<b>
<font face="Verdana, Arial, Helvetica" size=4>Step 5: If you chose online check, enter the details here:</font></b></td> </tr> 
<tr> 
<td width=100% height=15></td> </tr> 
<tr> 
<td width=100%>
<font face="Verdana, Arial, Helvetica" size=2>
<b>How this works:</b></font> 
<ul> 
<li>
<font face="Verdana, Arial, Helvetica" size=2>Void a check from your checkbook now and enter the information printed on that check into the form below. The form looks just like a check.
<br></font></li> 
<li>
<font face="Verdana, Arial, Helvetica" size=2>The amount will be directly withdrawn from your checking account within 24 hours. You must have sufficient funds in your account today to proceed.
<br></font></li> 
<li>
<font face="Verdana, Arial, Helvetica" size=2>This option is only available for U.S. residents or businesses, with a U.S. checking account. International customers may only order by credit card.
<br></font></li> </ul> </td> </tr> 
<tr> 
<td width=100% height=10></td> </tr> 
<tr> 
<TD> 
<TABLE width=550 align=center bgColor=#004080 border=0 cellPadding=2 cellSpacing=0 valign=center> 
<TBODY> 
<TR> 
<TD> 
<TABLE align=center background=http://home.earthlink.net/~ad61/texture0.gif bgColor=white border=0 cellPadding=7 cellSpacing=0 valign=center width=100%> 
<TBODY> 
<TR> 
<TD> 
<TABLE align=center border=0 cellPadding=1 cellSpacing=0 valign=center width=100% height=398> 
<TBODY> 
<TR> 
<TD colSpan=3 noWrap height=110>
<font face="Verdana, Arial, Helvetica">
<b>
<FONT color=red size=1>Your name as it appears on your check</FONT></FONT></b>
<BR> 
<INPUT maxLength=50 name=ECNameOnCheck size=20 onFocus="javascript:Il1iI1i1II1I1I111l(l1Ii1III1liIl);" onChange="javascript:I1lIIli1ilII11(this, I1Ii1II1liillIllii);">
<BR> 
<FONT face="Verdana, Arial, Helvetica" color=red size=1>
<b>Your address as it appears on your check</b></FONT>
<BR> 
<INPUT maxLength=50 name=ECCheckAddress size=20 onFocus="javascript:Il1iI1i1II1I1I111l(Illii1liIiIII1I11);" onChange="javascript:I1lIIli1ilII11(this, Illii1liIiIII1I11);">
<BR> 
<FONT face="Verdana, Arial, Helvetica" color=red size=1>
<B>Your U.S. city, state &amp; zip code</B></FONT>
<BR> 
<INPUT maxLength=50 name=ECCheckCity size=10 onFocus="javascript:Il1iI1i1II1I1I111l(lIIl1IIllili);" onChange="javascript:I1lIIli1ilII11(this, lIIl1IIllili);">, 
<INPUT maxLength=2 name=ECCheckState size=2 onFocus="javascript:Il1iI1i1II1I1I111l(IlI11liI1llll1Ii);" onChange="javascript:lI1llI1II1li(this);"> 
<INPUT maxLength=10 name=ECCheckZipCode size=10 onFocus="javascript:Il1iI1i1II1I1I111l(lI1IiIiII1iI);" onChange="javascript:Ili1lIlliI1lIIiiI1l(this);"></font> </TD> 
<TD align=center colSpan=3 vAlign=top height=110>&nbsp;</TD> 
<TD align=right noWrap vAlign=top height=110>
<font face="Verdana, Arial, Helvetica" color=red size=1>
<b>Check Number</b></FONT>
<BR> 
<INPUT maxLength=6 name=ECCheckNumber onFocus="javascript:Il1iI1i1II1I1I111l(I1ilI1ii11iIII1Iil1);" onChange="javascript:ll1iIiIiliIiIil11I(this);" size=8>
<BR> 
<BR> 
<FONT color=black size=1 face="Verdana, Arial, Helvetica">
<b>Date:</b></font>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<font size=2>
<i> 
<SCRIPT language=JavaScript> 
<!--
document.write(Ii1Il1Il1lIl1lII(lll1il1ill1iiiI(), "", 8, l1111iill1i11l(), 13)); //--> </SCRIPT></i> </TD></TR> 
<TR>
<!-- This row is used to make sure the table looks the same in all browsers... DO NOT REMOVE --> 
<TD>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD> 
<TD>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD> 
<TD>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD> 
<TD>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD> 
<TD>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD> 
<TD>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD> 
<TD>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD> </TR> 
<TR> 
<TD align=right height=28>
<FONT size=1 face="Verdana, Arial, Helvetica">
<FONT color=black face='Verdana, Arial, Helvetica' size=1>
<b>Pay to The
<BR>Order of:</b>
<br></FONT></FONT></TD> 
<TD colSpan=5 align=left height=28>
<FONT color=black size=3>
<i>&nbsp;IRB, Inc.</i></FONT></TD> 
<TD> 
<table border=2 cellpadding=0 cellspacing=0 width=100% bordercolor=#000000> 
<tr> 
<td width=100%>
<FONT face="Verdana, Arial, Helvetica" size=4>
<B>$</B>&nbsp;&nbsp;</font>
<FONT size=4>
<i> 
<SCRIPT language=JavaScript> 
<!--
document.write(liiIiIlI1iiiiilii(li1lIl1Ii1IllIl())); // --> </SCRIPT> </i> </td> </tr> </table> </TD> </TR> 
<TR> 
<TD></TD> 
<TD colSpan=5 vAlign=top>
<font face="Verdana, Arial, Helvetica">
<IMG src=http://home.earthlink.net/~ad61/black.jpg width=100% height=1 border=0></font></TD> 
<TD></TD> </TR> 
<TR> 
<TD colSpan=6 vAlign=bottom height=18>
<FONT color=black face='Verdana, Arial, Helvetica' size=2>&nbsp;</FONT></TD> 
<TD noWrap height=18>
<FONT color=black face='Verdana, Arial, Helvetica' size=1>
<b>U.S. Dollars</b></FONT></TD></TR> 
<TR> 
<TD colSpan=6 vAlign=top height=10>
<font face="Verdana, Arial, Helvetica">
<IMG src=http://home.earthlink.net/~ad61/black.jpg width=100% height=1 border=0></font></TD> 
<TD></TD></TR> 
<TR> 
<TD align=left colSpan=7 height=15>
<font face="Verdana, Arial, Helvetica" color=red size=1>
<b>Bank name as it appears on your check</B></FONT>
<BR> 
<INPUT maxLength=50 size=10 name=ECBankName onFocus="javascript:Il1iI1i1II1I1I111l(liili11i111l11lill1);" onChange="javascript:I1lIIli1ilII11(this, I1Ii1II1liillIllii);">
<BR> 
<font face="Verdana, Arial, Helvetica" color=red size=1 color=red size=1>
<b>Bank city &amp; state</b></FONT>
<BR>
<INPUT maxLength=50 name=ECBankCity size=15 onFocus="javascript:Il1iI1i1II1I1I111l(lIIl1IIllili);" onChange="javascript:I1lIIli1ilII11(this, lIIl1IIllili);">
<INPUT maxLength=2 name=ECBankState size=2 onFocus="javascript:Il1iI1i1II1I1I111l(IlI11liI1llll1Ii);" onChange="javascript:lI1llI1II1li(this);"> </font></TD></TR> 
<TR> 
<TD align=left colSpan=5 height=28 valign=top>
<font face="Verdana, Arial, Helvetica" color=red size=1>
<b>Bank phone number</B></FONT>
<BR> 
<INPUT maxLength=20 name=ECBankPhone size=20 onFocus="javascript:Il1iI1i1II1I1I111l(I1II11IIll1i1I1);" onChange="javascript:liIi1lIIiIl(this);">
<br> 
<FONT color=black face="Verdana, Arial, Helvetica" size=1>
<b>Memo:
<br></b></FONT></font></TD> 
<TD align=left colSpan=2 height=28>
<b>
<FONT color=red face='Verdana, Arial, Helvetica' size=1>IN LIEU OF SIGNATURE:
<br> 
<br> 1.) type your social security or
<br> federal tax id number here:</FONT></b></TD></TR> 
<TR> 
<TD colSpan=4 valign=top height=23> 
<FONT size=2>
<i> 
<SCRIPT language=JavaScript> 
<!--
document.write(IlIilIIiliiI[IiIiiliiii111i()]); // --> </SCRIPT> </I></FONT> </TD> 
<TD align=right valign=top height=23>
<FONT color=black face="Verdana, Arial, Helvetica" size=1>
<b>Signature:&nbsp;</b></FONT></TD> 
<TD colSpan=2 height=23>
<INPUT maxLength=11 name=TaxID size=11 onFocus="javascript:Il1iI1i1II1I1I111l(lI1111lIIiIIll);" onChange="javascript:I1l1Iil1Ii1Il11I1I1(this, true);"> </TD></TR> 
<TR> 
<TD colSpan=4 valign=top height=30>
<font face="Verdana, Arial, Helvetica">
<IMG src=http://home.earthlink.net/~ad61/black.jpg width=200 height=1 border=0></font></TD> 
<TD align=right valign=top height=30></TD> 
<TD colSpan=2 height=30>
<b>
<FONT color=red face='Verdana, Arial, Helvetica' size=1>2.) enter your U.S. driver license
<br> state and number here:</FONT></b>
<br> 
<INPUT maxLength=2 name=DriverLicenseState onFocus="javascript:Il1iI1i1II1I1I111l(IIi1111iI1l1i);" onChange="javascript:lI1llI1II1li(this);" size=2> 
<INPUT maxLength=50 name=DriverLicenseNumber onFocus="javascript:Il1iI1i1II1I1I111l(Ii11i1iIliIlI1ill);" onChange="javascript:I1lIIli1ilII11(this, IiIilIIIiliiili11li);" size=12> </TD></TR> 
<TR> 
<TD align=middle colSpan=7>
<FONT size=1 face="Verdana, Arial, Helvetica">&nbsp;</FONT></TD></TR> 
<TR> 
<TD align=center colSpan=7>
<b>
<FONT color=red face='Verdana, Arial, Helvetica' size=1>Bank Routing Code and Bank Account Number</FONT></b></TD></TR> 
<TR> 
<TD align=center colSpan=7 height=34>
<IMG src=http://home.earthlink.net/~ad61/1.gif width=15 height=28>&nbsp;
<INPUT maxLength=9 name=ECBankRoutingCode size=9 onFocus="javascript:Il1iI1i1II1I1I111l(Ii1l11illii1ll);" onChange="javascript:l1l1iI11lIiiIII(this);">&nbsp;
<IMG src=http://home.earthlink.net/~ad61/1.gif width=15 height=28>&nbsp;
<INPUT maxLength=20 name=ECBankAccountNumber onFocus="javascript:Il1iI1i1II1I1I111l(IlIll1I1liili11);" onChange="javascript:IiIlillilIiI1iili(this);">&nbsp;
<IMG src=http://home.earthlink.net/~ad61/2.gif width=15 height=28></TD> </TR> </TBODY> </TABLE> </TD> </TR> </TBODY> </TABLE> </TD> </TR> </TBODY> </TABLE> </TD> </tr> 
<tr> 
<td width=100% align=center valign=top>
<font face="Verdana, Arial, Helvetica" size=2>
<br> Example: 
<IMG src=http://home.earthlink.net/~ad61/micr_usd3.gif width=359 height=35 align=center> </font></td> </tr> 
<tr> 
<td width=100% height=10></td> </tr> 
<tr> 
<td width=100% valign=top>
<font face="Verdana, Arial, Helvetica" size=1> 
<font face="Verdana, Arial, Helvetica">
<img alt="SCAN database of bad check writers" border=0 src=http://home.earthlink.net/~ad61/scan.gif align=right width=117 height=76 hspace=5></font></a>
<font face="Verdana, Arial, Helvetica">
<b>Fraudulent Check Information Warning:</b> </font>
<font face="Verdana, Arial, Helvetica">In the eyes of the law, authorizing a worthless online check is as illegal as signing a worthless paper check. Check fraud is a serious crime which we will report immediately to the District Attorney in your state (as traced from your Internet/IP address). We're filing dozens of criminal complaints a month. If your online check is returned for any reason or contains bogus information, a criminal complaint 
<i>will</i> be filed against you at the Attorney General's office in your state. In addition, a $25 processing fee 
<i>will</i> be charged to your account for each time your check is returned unpaid to us, in addition to your own bank's fees, and you 
<i>will</i> be automatically blacklisted in SCAN, the nationwide database of bad check writers, which will eliminate your checkwriting privileges at millions of businesses and may make it impossible for you to open another checking account.
<br></font></font></li> </td> </tr> 
<tr> 
<td width=100% height=15></td> </tr> 
<tr> 
<td width=100% bgcolor=#E7E7CE>
<b>
<font face="Verdana, Arial, Helvetica" size=4>Step 6: Press &quot;Place Order Now&quot; to finish your order!</font></b></td> </tr> 
<tr> 
<td width=100% height=10></td> </tr> 
<tr> 
<td width=100% height=10> 
<font face="Verdana, Arial, Helvetica" size=2> Before you submit your order, please read the following:</font> 
<ul> 
<li>
<font face="Verdana, Arial, Helvetica" size=2>
<b>Accuracy:</b> Please review all the information you entered for accuracy. We will not be responsible for wrongly entered information.
<br></font></li> 
<li>
<font face="Verdana, Arial, Helvetica" size=2>
<b>Returns &amp; Refunds:</b> Please refer to the merchant's returns &amp; refunds policy outlined on the previous page.
<br></font></li> 
<li>
<font face="Verdana, Arial, Helvetica" size=2>
<b>Click only once:</b> To prevent multiple charges on your account, please click the button below only ONCE. The real-time ordering process may take up to one minute. Please be patient -- if you haven't received an e-mail confirmation about your order within one business day, please place your order again.
<br></font></li> </ul> 
<br clear=all> </td> </tr> 
<tr> 
<td width=100% align=center> 
<p align=center>
<input type=submit value="To Order Now, Click Here Only ONCE!" name=Button1></td> </tr> </table> </form> </CENTER> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> 
<BR> </BODY> </HTML> 
