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				*ChexCard 4 U* *Order ChexCard*



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								Order Your Prepaid ChexCard Mastercard For Only $69.95 Make Money Order Or Cashier's Check Payable To: HIGGS-FREEMAN This $69.95 Charge Includes Card Processing, Production and Shipping Fees. PLEASE PRINT THE ORDER FORM. FILL IN THE REQUIRED INFORMATION. MAIL WITH YOUR FULL PAYMENT TO: HIGGS-FREEMAN C/O: ChexCard 4 U P.O. Box 76090 Los Angeles CA 90076 PRINT ORDER FORM NOW First Name: ................................................................................................. Last Name: ................................................................................................. Street Address: ........................................................................................... City: ............................................................................................................. State: ........................................................................................................... Zip/Postal Code: ......................................................................................... Country: ...................................................................................................... Home Phone: .............................................................................................. E-Mail: ........................................................................................................ Mother's Maiden Name: ........................................................................... Card Holder's Signature: X........................................................................ Additional cards may be issued at $25 each. Please provide same information for all additional card holders. Upon receipt of your application/order form and payment, your ChexCard Mastercard will be issued promptly, directly from the Bank, with complete instructions on how to activate and use your card. You will select a PIN # to perform your transactions. Cards will be issued within 10-14 business days. ChexCard4U@hotmail.com We Are Available Monday Thru Friday, 9am - 5pm You May Call Us During These Hours @ 323-815-9061 And Send Faxes During These Hours @ 323-815-1066**



		*HIGGS-FREEMAN, C/O: ChexCard 4 U, P.O. Box 76090,* *Los Angeles, CA 90076*