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
___ ___	Viatical Transactions book One-year subscription Other back issues (please list):	$ 30*  $120	____ ____
___ ___ ___	__________________________ __________________________ __________________________	____ ____ ____ Total**	____ ____ ____ ____

___   My check is enclosed

___   Charge to my (circle one):    Visa    MasterCard

Credit card #: _______ - _______ - _______ - _______

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

Signature: ______________________________________

Print Cardholder Name: _____________________________

Name and Shipping address: _________________________ _________________________ _________________________ _________________________

Billing address (if different): _________________________ _________________________ _________________________ _________________________