PrepaidOrder

Prepaid Legal Service Order Form

(Required fields are marked with a *)

I am ordering the

· Only available through online purchase.

· A 40% discount from our standard rates.

Please provide the following contact information:

First Name*

Last Name*

Middle Initial

Title

Organization

Street Address*

City*

State/Province*

Zip/Postal Code*

Country

Daytime Phone*

E-mail*

Website

Please describe yourself*:

Please let us know how you were referred*:

Title of work or project:

(Enter "untitled" if you cannot release the name or if there is no title)

Please provide any specifics about the services needed: (Up to 1000 Characters)

List your entertainment organization memberships: (optional)

TERMS AND CONDITIONS

Please download the Prepaid Legal Service Package Terms and Conditions.

ELECTRONIC SIGNATURE

Pursuant to the ‘‘Electronic Signatures in Global and National Commerce Act,’’ (ESIGN Act), this application will be "signed" by entering any alpha/numeric character(s) or combination thereof of your choosing. Generally you should simply enter your name, although acceptable signatures could include /john doe/; /jd/; or /123-4567/

AGREED TO AND ACCEPTED

- Enter Signature Here*

– to the use of an electronic signature and the ESIGN Disclosure Statements.*