First Name:

Last Name:

Billing Address:

City: State:

Zip Code:

To determine your type of service,

you must choose one:	Citizen
	Lawyer
	Bondsman

How will you pay for your service?

Credit Card	Card # - -
- thourgh our secure on-line service.	Exp. Date /
	Type: MCVisaAMXDiscover
Check or Money Order Payable to:
Legal Express

You will be e-mailed when your credit card has been approved or your check or money order have arrived. Your date of account activation will be included.