Please print out the following form, fill it out and mail or fax to:

Lenders' Podium
20660 Stevens Creek Blvd., Suite 238
Cupertino, CA 95014
Fax:  415-707-6800

or Purchase Online

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	Yes, I am ordering Asset-Based Loans Audio CDs, Legal Forms and/ or Field Exam Template*
		Also attending the Asset-Based Loans Conference
			Audio CDs $895
			Legal Forms Notebook $495   NOTE: One copy of the notebook is included in the course materials.
			Combo (Audio CDs, Legal Forms and Filed Exam Template) $1,195
		Not attending the Asset-Based Loans  Conference
			Audio CDs $1,195
			Legal Forms Notebook $695
			Combo (Audio CDs, Legal Forms and Field Exam Template) $1,495
* California residents will be charged 7.75% sales tax. * Non-Refundable (refer to "Audio CDs, Legal Forms & Field Exam Template" page under "Order Policy" for details)

First Name	. . . . . . . . . . . . . . . . . . . . . . . .
Last Name	. . . . . . . . . . . . . . . . . . . . . . . .
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Fax	. . . . . . . . . . . . . . . . . . . . . . . .
E-mail	. . . . . . . . . . . . . . . . . . . . . . . .
Make check payable to: Lenders' Podium, or
Bill my credit card:American Express Visa MasterCardDiscover Card Diners Club
Credit Card Number:
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Exp. Date
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Security Code (CVV2 / CVC2):	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . .
Credit Card Billing Address	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name on Credit Card	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . .
Signature	. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . .
I would like to receive credits for CLE (for attorneys only) in the state of:  . . . . . . . . . . . . . . . . . . . . . . . .
How did you hear about these products? Received a 5 panel brochure in the mail Received a 2 panel brochure in the mail                 Please refer to back panel of the brochure near your address and check one:                ABBS-AB1  ACBL-AB1   BZ-AB1        CO-AB1   DEVF-AB1                  FM-AB1      IAC-AB1      MHBK-AB1  TAM-AB1                   Other: (Please specify)______________________________________________

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