# INTRODUCING NON-SURGICAL LIPOSUCTION! NOW AVAILABLE IN U.S.A.!

gangr@prontomail.com
Sun, 30 Aug 98 18:53:39 EST

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Greetings,

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This revolutionary medical breakthrough in Liposome Technology utilizes a
transdermal delivery system that results in real fat loss in 24 Hours!
Without surgery, diet or exercise! Results are GURANTEED.

For more information and to read our NEWS RELEASE,. Print this whole page
out from your computer; Complete the Information Request Form below, LEGIBLY,
(It is best to type it); And fax your completed Information Request Form to:
919-933-9484

NON-SURGICAL LIPOSUCTION
INFORMATION REQUEST FORM

NAME________________________________________________________________

COMPANY____________________________________________________________

STREET ADDRESS_____________________________________________________

CITY/STATE/ZIP________________________________________________________

TELEPHONE______________________________ Fax:________________________

E-MAIL ADDRESS______________________________________________________

DATE__________________________________ Our Ref: NSL8/28/98/2FFBK

[ ] INTERESTED IN DISTRIBUTING YOUR PRODUCT. Please send me re-seller
information.

OPTIONAL INFORMATION
(Thank you for taking the time to answer these questions.)

AGE: [ ] 18-24 [ ] 25-34 [ ] 35-44
[ ] 45-54 [ ] 55-64 [ ] 65 & over

[ ] FEMALE [ ] MALE

HOW MANY INCHES WOULD YOU LIKE TO LOSE?

______WAIST ______HIPS _____THIGHS _____UPPER ARMS

HOW MUCH WEIGHT WOULD YOU LIKE TO LOSE?

[ ] Under 10 lbs [ ] 10-20 lbs
[ ] 20-30 lbs [ ] 30-40 lbs [ ] 40-50 lbs
[ ] Over 50 lbs

EXERCISING NOW? [ ] YES [ ] NO
DIETING NOW? [ ] YES [ ] NO

INCOME:
[ ] Under $25,000 [ ] $25,000-$50,000
[ ] $50,000-$75,000 [ ]$75,000-$100,000
[ ] $100,000 & Over

THANK YOU! YOU WILL RECEIVE COMPLETE INFORMATION VIA RETURN EMAIL WITHIN 24
HOURS.

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