Q&A Service, Question Order Form

You must fill in this form to expect a response. Print out or copy this form, fill it in and send it to me as instructed below.

Your Question:

 

 

 

 

Your Name:
Business or Institution:
Address:
Town, State, Zip:
Phone:
Best time of day and week to receive a call:
Email:

[ ] You require that all questions and replies are kept private.

[ ] You allow questions and replies to be published.

If your question is used in a publication do you prefer to be identified:

[ ] by your name only
[ ] by your town only
[ ] by your name, town and business
[ ] remain anonymous

 

Check one of the four boxes to the left to select your level of payment and service.

  Payment
Level		 Response * Features
[ ] $50. Within 3 Days
  • Reply assured
  • Allows one "look up" in my library
[ ] $100. Next Day
  • Reply assured
  • Allows up to 30 minutes of reseach
  • Might include a photo scan, or article copy
  • Includes referrals
[ ] $200. Next Day
  • Reply assured
  • Allows up to 1 hour of research
  • I may contact you to learn more about your situation
  • Might include a custom sketch, photo scan or article copies
  • Includes top priority reply to a followup question
  • Includes referrals
  * except when I am traveling, which is about twice a month, when all replies may be delayed up to one week

 

Your Payment: [ ]Visa, [ ]MC, [ ]Check Enclosed


Print Name as it Appears on your Credit Card:

----------------------------------------------------
Card Number:

------------ ------------ ------------- -------------

Signature, Exp. Date:

--------------------------------------------, -- --/-- --,   3-digit security code on back of card: ----/----/----
(signature not needed if emailing order)

Instructions:

Print out and mail this order form to: Q&A, 26 Higgins St., Portland, ME, 04103
Or, print out, fill in and fax this order form to: 207 773-2306 (This is a voice and fax number. Even if you hear a voice message, just go ahead and send your fax.


Terms of Use: By submitting a question to the Q&A Service you agree to the following terms. All answers are provided for informational and educational purposes only. You agree to hold John Leeke harmless for the results of any use you may make of any answers.

Signature Required:

 

-----------------------------------------, date:  ---/---/------


John Leeke's Historic HomeWorks™

    207 773-2306      26 Higgins St. Portland, ME  04103
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