NAME:________________________________________DATE:_____________________
MAILING ADDRESS:________________________________________________________
__________________________________________________________________________
CITY:________________________________STATE:_______________________________
ZIP CODE:______________________COUNTRY:_________________________________
PHONE NUMBER:_____________________________
EMAIL ADDRESS:_____________________________

Please accurately enter the Contact Number(s) you wish to have sent to you. $5.00 USD per Contact ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Total charge for this order is:$____________
Would you like us to send your addresses Via Snail mail______ or Email______.
Mark method of payment: Cashiers Check_______ Money Order_______ Cash_______.

All sales are final, no refunds.

Please make payable to Parrish Knapp.

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I understand that AGPS is an introduction service only and makes no other promises.
I hereby waive any and all liability or claims against them.
Any use of their material or services for commercial purpose is illegal, and will be subject to prosecution.

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