Order Your LIFE HAMMER(s) Today!

Please Feel Free to Print Out This Order Form, Enclose Payment and Mail to the Address Provided.

USCCCN INTERNATIONAL, INCORPORATED
Post Office Box 663
South Plainfield, NJ 07080-0663
Fed. ID# 22-3248936

E-mail: EscapeMaster@aol.com

Please Send Me/Us _____ LIFEHAMMER Unit(s) @ $29.95 Each (Includes USPS Priority Mail Shipping). NJ(Only) Purchasers Must Add 6% NJS Tax Unless Exempt. All Orders Must Be Prepaid by Check or Money Order - Payable to: USCCCN INTERNATIONAL, INCORPORATED.

To Pay By Credit Card - Please Use the Form Below.

Name:____________________________________________________

Title:___________________

Agency/Org/Inst:_________________________________________

Address:_________________________________________________

City:_________________________State:________Zip:_________

E-Mail:__________________________________________________

CREDIT CARD ORDERS: Mail Credit Card orders to the Address Provided or Fax to (973) 776-3902 (At The Prompt Dial 8876 and Immediately Press Your FAX START Button).

Credit Card: ____Visa ____MasterCard ___Discover ___AMEX

Credit Card Number: ____________________________________

Expiration Date: Month______ /Year_______

Name on Credit Card:____________________________________

Signature:________________________________________________ Check Off For Free Info:

___Affordable Dental, Vision, Prescription and Chiropractic Health Care Plan @ $11.95 Per Month (Single Individuals) or $19.95 Per Month (Entire Family/Household).

___A Lucrative Business of Your Own; Immediate Income; 30% Commissions on Every Processed Application; A Complete Health Coverage Plan for Your Entire Family/Household; and Lifetime Willable and Sellable Residual Income.

It's NOT Insurance! It's AMERIPLAN Brought To You By USCCCN International, Incorporated - I/B#11993333

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