United Refund Services
PO Box 496378
Port Charlotte, Florida 33949-6378
I have enclosed my $25.00 payment in the form of a:
Personal Check ___ Money Order ___
Cashier's Check ___
Please send my Quick-Start Premium Kit to the following e-mail address:
______________________________________
Please include the following two state listings with my kit:
State Listing #1 ________________________________
State Listing #2 ________________________________