|
The Ultimate Results
Enrollment Form
Yes Betsi, I am ready to achieve my Ultimate Results!
Please process my 100% Risk-Free
Enrollment Form so I can get on the fast track to success.
Name______________________________________________________________
Company___________________________________________________________
E-mail: ___________________@_______________________
My choice is:
[ ] 3 Payments of $7,366 (Saving $7,366!) or
[ ] One payment of $20,598 (Save another $1,500 for a total $8,866) savings!)
[ ] Use my Credit Card please:
[ ]
M/C [ ] Visa [ ] Disc
[ ] AMEX
Card # __________________________________________
Exp.
Date:_______________
Credit Card Billing Address:
__________________________________________________________________
City: ____________________________________ State: _________
Zip:
____________ |
OR
[ ] Draft my checking account please:
I (we) hereby authorize Meridian Associates Inc. (THE COMPANY) to initiate
a debit of my checking account at the financial institution listed below
(THE FINANCIAL INSTITUTION), and, if necessary, initiate adjustments for
any transactions credited/debited in error.
__________________________________________________________________
Name of Financial Institution
__________________________________________________________________
Financial Institution Address - Branch, City, State & Zip
________________________________________________________
________________________________________________________
Financial Institution Routing Number: Account Number
(Look between these symbols 1: :1 on the bottom left of your check)
Signature: _______________________________________________________________
Phone: ____- ____-_________ Fax: ____- ____-_________
|
FAX your order to 817-594-3397 |