ORDER FORM You may either pay by check or by using a credit card. Fax Order: Complete the Order form > PRINT > Fax it to (908) 233 - 5982 Mail Order: Complete the Order form > PRINT > Mail with check made payable to:                   The Lease Check® Institute, 617 Boulevard, Westfield, NJ 07090-3209   Title Cost Quantity Total The LeaseCheck System - PRO $299 $ PLUS: Shipping/Handling (per copy) $9.95 @ $     SUBTOTAL $ PLUS: NJ Residents Sales Tax - 6%     $     TOTAL AMOUNT DUE $ Name: Title: Organization: Street Address: City: State: Zip Code: Phone #: Fax: Email Address: PAY: CHECK (Enclosed) VISA MasterCard American Express Card Number: Expiration Date: Signature of Cardholder:

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