Attraction Brochure Order Form (Non-Partner) Please be sure to submit all orders at least three weeks before the needed delivery date. All companies are eligible for one-time order of 25 brochures at no charge. Contribution Amount * 25 Brochures (one-time order per company) - $ 0.00 100 Brochures - $ 135.00 250 Brochures - $ 175.00 500 Brochures - $ 225.00 750 Brochures - $ 285.00 1000 Brochures - $ 325.00 Total Amount Attraction Brochure Order (General) First Name * Last Name * Email * Phone * Company * Shipping Address * City * State * - select State/Province - Alabama Alaska Alberta American Samoa Arima Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Chaguanas Colorado Connecticut Couva-Tabaquite-Talparo Delaware Diego Martin District of Columbia Eastern Tobago Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northern Mariana Islands Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Penal-Debe Pennsylvania Point Fortin Port of Spain Prince Edward Island Princes Town Puerto Rico Quebec Rhode Island Rio Claro-Mayaro San Fernando San Juan-Laventille Sangre Grande Saskatchewan Siparia South Carolina South Dakota Tennessee Texas Tunapuna-Piarco United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Western Tobago Wisconsin Wyoming Yukon Territory Postal Code * Partner Affiliation * - select Partner Affiliation - Ameritas Lincoln Financial Mutual of Omaha Reverse Mortgage National Life Group Ohio National Penn Mutual Principal Prudential Financial SPS Family/Sigma No Affiliation Credit Card Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 My billing address is the same as above Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - United States Canada Trinidad and Tobago State/Province * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Review your contribution