Name _________________________________________________________________

Employer _______________________________________________________________

Position ________________________________________________________________

Business Address _________________________________________________________

_______________________________________________________________________

City, State, Zip ____________________________________________________________

Telephone (Work) _________________________________________________________

Fax Number _____________________________________________________________

E Mail Address ___________________________________________________________

Authorized Signature ________________________________________________________

Please fax this form to 508 788-6217 or mail this form with a check or purchase order payable to The Abrahams Group LLC for $199.00 to:

The Abrahams Group LLC
19 Ridgewood Street
Ashland, MA 01721

For more information contact Mark D. Abrahams at 617 803-8529 or at Bettergov@aol.com or visit www.TheAbrahamsGroup.com.