To order, please print and complete the form below and send it with your credit card instructions or your check payable to The Insurance Forum, P.O. Box 245, Ellettsville, Indiana 47429-0245, telephone (812) 876-6502.  Alternatively, you may place your credit card order by fax at (812) 876-6572, or toll-free (U.S. only) by telephone at (888) 876-9590.   We do not impose any mailing, shipping, or handling charges, but we require prepayment by check, MasterCard, or Visa. Indiana addressees please add 7% sales tax. For issues not listed on the order form, please indicate the dates of the issues and the prices in the blanks below.

Qty.

Item

Price

Amount

_____ _____ _____ _____ _____ _____

One-year subscription September 2007 special ratings issue Other back issues (please list): __________________________ __________________________ __________________________ __________________________

$120 $  25* ______ ______ ______ ______ Total**

______ ______ ______ ______ ______ ______ ______

_____   My check is enclosed

_____   Charge to my (circle one):       Visa         MasterCard

Credit card #: _________ - _________ - _________ - _________

Expiration date: ______________ Phone: ( ____ ) ____ - _______

CVV Code: _______ (3-digit code on back of card in signature area)

Signature: ___________________________________________

Print Cardholder Name: _________________________________

Name and Shipping address: _____________________________ _____________________________ _____________________________ _____________________________

Billing address (if different): _____________________________ _____________________________ _____________________________ _____________________________