Mail-in Order Form for
The Scholarship Guide

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Once you have filled out the form, mail it to us, along with a check or money order
(if not paying with a credit card) in the amount of $47 US to the following address:

eFinancialAid.com, Inc.
2104 Valleydale Lane
Encinitas, CA 92024-4240
USA

Need help with your order? Call us, toll-free at (800) 860-9891

Name: ______________________________________________________________

Desired Password: ___________________________________________________

E-mail Address: _____________________________________________________

Telephone #: ( ______ ) _____ - ___________

Note: Your receipt, including your username and password, will be sent to the e-mail address you have written above. If we are unable to contact you via e-mail, we will contact you via telephone within 24 hours of receiving your order.

Type of Card (Please circle one): Visa   Mastercard   Discover   American Express

Expiration Date (month, year): ____  / ____  ex. 07/05

Name on Card: _____________________________________________________

Card Number: ______________________________________________________

Billing Address, Line 1:______________________________________________

Billing Address, Line 2: ______________________________________________

City: _____________________________________________

State / Province: ___________________________________________

Postal Code: _________________

Country (if other than US): ___________________________________