Cockatiel Secrets Order Form

Mail or Fax in your order
Print out the following order form and either:

Fax it to (800) 710-2504 or

Snail mail it to:
Lucrum Inc.
P.O. Box 91914
Austin, TX 78709

Make sure you send both pages of this form!

Yes, rush me Cockatiel Secrets and Cockatiel First Aid.
We will email the instructions for downloading the ebooks to you within one business days of receiving your order.

Shipping Address:

Name: _________________________

Email: _________________________
(double check spelling as this is where your
download instructions for the eBook will be sent)

Company (optional): _________________________

Address: _____________________________

_____________________________________
(please be sure to enter a physical mailing address,
if you are ordering a printed manual)

City: _________________________

State: _________

Country: _________________________

Zip: _________

Phone: (___) ____ - ______
Billing Address (if different):

Name: _________________________

Email: _________________________

Company (optional): _________________________

Address: _____________________________

_____________________________________

City: _________________________

State: _________

Country: _________________________

Zip: _________

Phone: (___) ____ - ______

Payment Amount - $19.97 (electronic delivery only) add $10.00 for a printed book
Check one
(  ) $19.97 - I would like the electronic version only
(  ) $29.97 - I would like the electronic version and a printed manual shipped to me
The printed manual will ship out within one business days of receiving your order.

8.25% sales tax will be charged for orders in Texas.

Check one

(  ) I am enclosing a check or money order for the total amount. Please note that we do not accept checks by fax, so if you are paying by check you must mail it in.

(  ) I want to charge this purchase to my Credit Card

Credit Card (check one)

(  ) Visa
Card Number:
_________________________________________________________

(  ) MasterCard

Expr Date:
____________________
Security Code:
_____________

Signature:
_________________________________________________________

I authorize Lucrum Inc. to charge my credit card for this purchase.

Check one
( )	I am enclosing a check or money order for the total amount. Please note that we do not accept checks by fax, so if you are paying by check you must mail it in.
( )	I want to charge this purchase to my Credit Card

Credit Card (check one)
( )	Visa	Card Number:	_________________________________________________________
( )	MasterCard	Expr Date:	____________________	Security Code:	_____________
		Signature:	_________________________________________________________
			I authorize Lucrum Inc. to charge my credit card for this purchase.