Print out this form and mail it to Adult Student Grants, C/O WD Communications LLC, P.O. Box 2001, Fullerton, California, 92837.

Date: ____________________________________
Name: ____________________________________
Company/Institution: ________________________
URL: _____________________________________
Street Address: ____________________________
City: _____________State_____ Zip Code_______
Telephone: _____________ Fax: ______________

E-Mail Address (Required): ___________________
(Please print e-mail address clearly to ensure receipt of the report . The report is in Adobe Acrobe Reader format only. )

Payment by Credit Card:
Visa _________ MasterCard__________ American Express _________ Discover _________ Account number_____________________________
Exp. Date________
Card Verification Code (CVV2) (Required): _____________________________ (The Card Verification Code is the 3 number code on the back of the credit card on the signature strip to the right of the card number)

Name as it appears on the card__________________________________
Signature ___________________________________________________
(Unsigned orders cannot be processed)

______ Payment by Check/Money Order (Payable to WD Communications LLC)

______ Please e-mail me the special report, Scholarships for Re-entry Students: Grants and Retraining Assistance for Adults Returning to College (89 pages). Enclosed is $39.95 for a single user license. (Libraries, colleges and universities, and other organizations with multiple users need to request a multi-user license.)

If paying by check, please allow two to three weeks for payment processing.