PAYMENT METHOD:

(Please Check One)

______  Enclose Money Order or Cashier's Check to Beaubien Investment Co., LLC.
______  VISA ______  MasterCard ______  American Express ______  Discover

Card # ____________________________  Expiration Date _________________

Name as it Appears on Card __________________________________________

SHIP TO:

Name  ___________________________________________________________
Address  _________________________________________________________
City  ____________________________________________________________
State & Country  __________________________________________________
Zip/Postal Code  __________________________________________________
Email  ___________________________________________________________