INGER FAX SUBSCRIPTION FORM
      
                   
      
           Please provide all of the following information. Fax the
      
           completed form to 732-627-0798.
      
      
       1.  Item Selected
      
             The Inger Daily Briefing:  ___ $159/quarter
      
             The Inger Daily Briefing:  ___ $25/week
      
       2.  Name on Credit Card:  ______________________________ 
      
      
       3.  Street Address:       ______________________________
      
      
       4.  City:                 ______________________________
      
      
       5.  State:                ______________________________
      
      
       6.  Country:              ______________________________
      
      
       7.  Zip Code:             ______________________________
      
      
       8.  Telephone (day/night) ______________________________
      
      
       9.  E-mail Address        ______________________________
      
      
       10. Credit Card:  ___ Visa,  ___ MasterCard,  ___ Discover.
      
      
       11. Credit Card Number:   ______________________________
      
      
       12. Expiration Date:      ______________________________
      
      
       13. User Name:            ______________________________
      
           (User name must have exactly 10 characters with no blanks.)
      
      
       14. Password:             _______________________________
      
           (Password must have at least 4 characters with no blanks.)