2) Street Address:

3) City: xx4) State: Select One CANADA Puerto Rico ----------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming xxx 5) Zip Code:

6) Web Site Address (If Available):

7B) Select A Calling Duration: xx 5 Minutes xxx 10 Minutes xxx
xx 15 Minutes xxx 30 Minutes xxx 60 Minutes xxx 100 Minutes

8B) Select A Calling Duration: xx 5 Minutes xxx 10 Minutes xxx
xx 15 Minutes xxx 30 Minutes xxx 60 Minutes xxx 100 Minutes

9) You have the option for a custom greeting, recorded by professional talent in a sound studio. Please indicate your preference: Select One None Recorded by Professional Talent (FREE for orders of 250 or more cards) Recorded by Professional Talent ($45 for orders of less than 250 Cards)

10) How will you be using your custom phone cards? Select One Conference Trade Show Consumer Incentive Customer Gift Employee Gift Retail Sales Fund Raising Reunion Other

11) What is the deadline for your project? Select One 2 Weeks from today's date 3 Weeks from today's date 4 Weeks from today's date 5 Weeks from today's date 6 Weeks from today's date More Than 6 Weeks from today's date

12) How do you plan to design your custom phone card? Select One Already Designed In-House Design Staff Out-Source To Designer Request Bid From CPC Haven't Decided

13) Name of Contact:

14) Contact's Email Address:

15) Contact's Telephone Number:

16) When is the best time to call? Select One Morning Afternoon

17) Fax Number:

Comments/Special Requirements: