Bloodstock Research Information Services
                               P.O. Box 4097
                       Lexington, Kentucky 40544-4097
               Tel: (800) 354-9206           Fax: (859) 223-7024





                     Maiden Stats 2012 CD-ROM Order Form

Please send me ____ copies of Maiden Stats 2012 CD-ROM. 
I have enclosed $99.95 for each CD. (Kentucky residents add 6% sales tax.)

Method of Payment: __ Check Enclosed - payable to Bloodstock Research
          Bill my:   __ AMEX    __ Discover   __ VISA   __ MasterCard 

Card No. ____________________________________  Expires ____/____/____

Signature ____________________________________________________________

Credit Card Identification Code: ____________ (a.k.a. CVV2, CVC2, or CID)

Name _________________________________________________________________

Address ______________________________________________________________

City _______________________________  State __________  Zip __________

Phone ______________________________  Fax ____________________________





Send to:            Bloodstock Research Information Services
                    attn: Maiden stats cd
                    P.O. Box 4097
                    Lexington, Kentucky 40544-4097



Fax to:             1 859-223-7024