USCCCN INTERNATIONAL, INCORPORATED

Prepaid and Credit Card Order Form

1. Please Print and Complete This Order Form.  2. List Items You Wish to Order and Quantities Desired. 3. Individual Security/Law Enf Purchasers: Attach a Copy of Your Agency ID Card 4. FAX This Form with Your Credit Card Information to:  (908) 226-8715 ...or (5) Mail this Form with Your Check, Money Order or Credit Card Information ... to the address listed below: USCCCN INTERNATIONAL, INCORPORATED Post Office Box 663 South Plainfield, New Jersey 07080-0663 Fed. ID# 22-3248936

PRINT Name:_________________________________________________________________________________

Firm/Org/Agency/Inst:_________________________________________________________________________

Address:_____________________________________________________________________________________

City:____________________________________ State:___________________ Zip:________________________

Telephone: (_________) _______________________________ E-Mail:__________________________________

QUANTITY................ITEM...........................................................Price Each.................................TOTAL ..................

_______ STREET CRIMES: Street Smart Strategies for Law Enforcement - Check Off For Training Data

All Prices Include Shipping. All Orders Must Be PREPAID.           Subtotal of Order:$________________

**CHECKS/MONEY ORDERS Must Be Made Payable To: USCCCNII National Crime Commission):

Individual NJ (Only) Purchasers Must Add 6% NJ Sales Tax:       $________________ 

Total Including Sales Tax (NJ Individual Purchasers Only):          $____________________________

Total of Check/Money Order Enclosed:$___________________________

  ****CREDIT CARD ORDERS - Master Card / Visa / AMEX / Discover:

Sub-Total of Ordered Items:                                        $_______________________________

NJ (Only) Purchasers Must Add 6% NJS Tax             $________________ 

Total Including Tax (Individual NJ Purchasers Only):$__________________________

Credit Card: ___Visa __Master Card __AMEX __Discover ....................Expiration Date:________/_______

Credit Card Number:____________________________________________________________________________

Name on Card:_________________________________________________________________________________

Address of Cardholder:__________________________________________________________________________