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Fax Enrollment Form
____Yes, enroll me in your
“Ultimate
Insurance System”
Plus include all the bonus you mentioned in your
report. By ordering our system you have read and
understand our no risk 13-month Guarantee policy found
in our sales letter.
Please Rush Me the
“Ultimate Insurance System” at this special limited
price.
Great Deal! (__) Here’s
1 payment of $497 $397 (FREE
Priority Mail S&H)
Good
Deal! (__) Bill my credit card in 4 installments of
$121.00 (+$20 Priority Mail) Fax this form to
(800)
397-3840
and receive additional
$10.00 off the price.
____
YES, I WANT YOUR
72 HOUR QUICK RESPONSE LIMITED TIME ONLY OFFER :
Initial here to have
access
to our Free Trial offer “Annuity Pro Lead Capture Web
Page and Auto Responder email system and monthly
client
newsletter that can be personalized.”
Set up fee for website of $495 is waived. After 30 days
your
credit card will
be billed for $39.00.
Normal charge is $59.00. You can cancel website
and
client
newsletter at anytime.
Need simple username
extension for website like your first name or initials
_____________ password ______________
Send My System
To: (Please Print
Clearly)
Name:
____________________________________ Phone:
___________________________________
Address:
___________________________________ EMAIL:
_________________________________
City:
_____________________
State: ______ Zip Code:
_________ FAX:_________________________
Credit card Installment Plane:
If you wish to pay in 4 equal installments, your credit
card will be charged for the first installment
plus 3-Day Priority Shipping and Handling
the day we ship your order.
The second installment will be charged 30 days
later.
The third installment will be charged 60
days later. The fourth installment 90 days later.
S&H is
non-refundable.
Check payment:
If you pay by check, please make payable
to “Great Western Consulting LLC.” Personal Checks will
be held for 5 days,
cashiers checks and money orders will be
shipped immediately.
Thanks
Check or
Money Order is enclosed
Credit
Card Order: (__) Visa (__) Master Card (__) Discover
(__) AMEX
Name of
Card Holder (Please
Print):
_______________________________________________________________
Account
Number: _____________________________________ Expiration
Date: ______________
Authorized Signature:
_____________________________________ Date:
____________________
CID# _________
(Last 3#’s on back
of card for Visa, MasterCard, Discover. Last 4#’s on
front of card for AMEX)
1)
Call toll-Free:
(800)
808-6551
to order
2)
Send to:
Great Western Consulting LLC., 550 East 100 South,
Hyde Park,
UT. 84318
3)
TOLL-FREE
FAX To:
(800)
397-3840
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