INSTITUTE OF CONTINUING LEGAL EDUCATION IN GEORGIA 11/2011 Sorry, No Phone Orders! NAME________________________________________________________________________________________________________________________ GEORGIA BAR MEMBERSHIP NUMBER_________________________________ OFFICE PHONE (_________)___________________________ FIRM NAME___________________________________________________________________________________________________________________ STREET ADDRESS_______________________________________________________________________ SUITE/FLOOR NO._____________________ (Street address necessary -- Books are shipped by UPS) CITY____________________________________________________________________ STATE_______________ ZIP + 4______________-________ Please ship the following books: Quantity Publication No. Publication Title Unit Price Total Amount Please complete and return to: ICLE in Georgia · ATTN: Publications P.O. BOX 1885 · ATHENS, GA 30603-1885 Subtotal $____________ Orders delivered within Georgia add 6% state sales tax $____________ TOTAL AMOUNT $____________ I have enclosed a check for the total amount shown above ORCOMPLETE ENTIRE FORM I authorize ICLE to charge the total amount shown above to my MASTERCARD VISA AMEX Credit Card Number: Expiration Date: _______/_______ / Credit Card Verification Number: A three-digit number usually located on the back of your card. AmEx­ A four-digit number on the front. Signature: ________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Orders with credit card numbers can be faxed to: 706-354-4190