The Life Made Easy Company

LME Order Form:

(Please FAX this form back to us at: 513-322-7921)

Your FULL name/Title:

________________________________________________________________________

HOW DID YOU HEAR ABOUT US?

Search Engine( ) Friend( ) Web( ) Flyer( ) Other( )

Products wanted: (please use price information provided in quote given via fax/e-mail)

(1) PRODUCT NAME and #-_____________________________________________

PRICE $ _________________ how many? ____________

(2) PRODUCT NAME and #- ____________________________________________

PRICE $ _________________ how many? ____________

*Shipping $______________ *Tax $ __________ *Discounts if any $____________

TOTAL DUE (please add shipping & tax above)$$__________________

Your Phone: include area code ___________________________________________

Your exact postal address:_____________________________________________

_____________________________________________________________________

Your E-MAIL: ________________________________________________________

Is product going to an address different from yours?

Yes( ) No( )

If so, what is recipient’s name? ___________________________________________ (If there are multiple recipients, please type all addresses on separate sheet of paper and fax with this form or send address-list to our attention via e-mail.)

Their Address?_____________________________________________________________

Your greeting message:______________________________________________________

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Method of Payment: Credit Card( ) Check( ) Money Order( )

(make checks payable to: Life Made Easy) U.S. DOLLARS ONLY

Credit Card: VISA( ) MC( ) AMEX( ) (LME will use PayPal to process your credit card)

CARD#:___________________________________ Expiration date:_____________

Exact name on card: _____________________________________________________

Billing address of card if different from above:_________________________________

Credit card 3-digit security code___________(usually located on the back of card, the last 3 digits at the end of the number series near signature. American Express 4-digit code on front of card)

Your Signature__________________________________________ Date__________

All orders in Ohio must include 6.5% sales tax plus shipping charges

Mail to: Life Made Easy Co. P.O. BOX 36543 CINCINNATI, OHIO 45236

Phone: 513-841-0654 * Fax: 513-322-7921 * email: sales@LifeMadeEasy.org * web: www.LifeMadeEasy.org

***THIS FORM MUST BE COMPLETED IN ITS ENTIRETY IN ORDER TO PROCESS ORDER***