Contract for Direct Mail Dealership

							DIRECT MAIL ORDER FORM
TO:        David C. Nelson               FROM:
           Hole-in-One U.S.A.
           9500 Prototype Ct.
           Reno, NV 89521
Phone:     1-800-383-7273
Fax:       1-775-852-7274                Phone:
E-mail:    sales@hiousa.com              Fax:
CC:                                      E-mail:

REMARKS:                 Fax a          Fax a quote        Email a contract        Email a quote        Please call
                         contract
                                    DIRECT MAIL INFORMATION:
Promotion
(Check box):                        Sequential Number Match                           Six-Digit Number Match
    Date (s) of Promotion
           Value of Prize(s)
(Complete following for Sequential Number Match):
 # of Mailers:
    Mailhouse                                                                   State:
(Circle following for Six-Digit Number Match):
VIN Number                             OR                      Preselected Number
  Match to: Driver’s License                          OR            Social Security Number
Type of Advertising (circle)          Mailers          Newspaper              Radio          T.V.       OTHER
Dealership/Location                                                           Contact:
  Address:
  E-Mail Address:
   Phone:                                                   Fax:

   MC /Visa / AMEX#                                                                       Exp. Date
         Card Holder                                                                     3 or 4
        (please print)                                                                    digit Sec #

       Billing Address                                                                           Zip