Career Network Associates order form for Consultants

Order Form

Complete our form(s), print out, and send to us - along with your remittance - by regular mail. Please make your check payable to Stephen P. Davis.

E-mail address:
First name:
Last name:
Street address:
Street address (cont.):
City:
State:
Postal code:
Area/Phone #1:
Area/Phone #2:
Consulting, Media Resource, Network and/or Registry Area(s) selected: Please write exactly as on the Areas of Study listings.
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#10
State Selectors:
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Addendum Sheet If you need more room than the Order Form provides, or you did not find items in the databases that pertain to your area of interest, please use this addendum sheet to tell us what they are. Be as specific as possible; we will attempt to fulfill your request by doing a personalized data search. Add this figure to the total charges reflected on your order form.

Calculate cost of service:
Number of areas selected		x $25.00 =
Plus $1.00 for postage and handling = Total cost:
PAYMENT METHOD
Check enclosed in the amount of
Charge my credit card the amount of
Credit Card: (If active)
Expiration Date:
Card Number:

When you are finished, please print out the order form and mail to:

Career Network Associates
2730 Coyote Lane
Willits CA 95490

State Selectors