After filling out this form, print it, submit it and then mail to:
CANDI
Consumer Alliance Networking Demonstrations Inc.
P. O. Box 69024
St. Louis, MO 63169-0024

ORDER 100 PROGRAMS AFFILIATE WEB SITE FOR:

BUSINESS NAME:
FIRST NAME:
LAST NAME:
ADDRESS:
CITY:
STATE:
ZIP CODE:
AREA CODE:
PHONE:
FAX:
EMAIL:

PAYMENT METHOD
FOR
100 Programs: Affiliate Web Site
Enclose $25.00 Per Replicated Web Site or $50.00 Per Independent Web Site

Personal Check * Money Order * Cashier's Check *
* Make payable to CANDI

AMOUNT ENCLOSED:

NOTE: All returned checks (insufficient funds, uncollected funds, etc.) will be charged an additional $25 processing fee.
IMPORTANT: All personal and cashier's checks NOT drawn on a Missouri state bank or money orders NOT issued by the
United States Postal Service will delay activation of your web site by at least 15 business days to allow for bank clearance.

Hit File/Print to make your copy of this form. Then mail it to us:
Candi Jefferson
CANDI Processing Dept.
Consumer Alliance Networking Demonstrations Inc.
P. O. Box 69024
St. Louis, MO 63169-0024


Submitting this page will only send us an e-mail copy of your payment.
You still need to print it out and mail it in with your payment.

© 2001 Consumer Alliance Networking Demonstrations Inc. All rights reserved.