 | ||||
| ||||
| ||||
APLICACIÖN-ASOCIADO
World International Networkers
Associate (Sponsor) Name:
Associate (Sponsor) ID:
ASSOCIATE-APPLICATION
1631 East Vine Street Suite C
Kissimmee, Florida 34744
Fecha / Date:
FIRST NAME / Nombre
MIDDLE NAME - Inicial
LAST NAME / Apellido
DOB / FECHA DE NACIMIENTO
SOCIAL SECURITY / SEGURO SOCIAL
E:MAIL
MAILING ADDRESS / DIRECCION
CITY / CIUDAD
STATE / ESTADO
ZIP CODE
HOME PHONE / TELEFONO CASA:
CELLULAR PHONE / TELEFONO CELULAR
Credit Card Authorization For Monthly Payments
Card Type
Credit Card Number
S. Code
Expiration Date
mm / yy
Name as it apperrs on the Credit Card
Billing Address
City
State
Zip Code
Appoved
Print Name
Date
mm/day/ yy
mm/day/yy
Email:win@yahoo.com.com
www.winassociate.com
| ||||
TOTAL $139.95
SECUNDARY PHONE
PAYMENT INFORMATION
(Información de Pago)
(LTC) Membership & Business Kit)
(Amount selected above is to be drafted immediately)
WIN CLUB PLAN
(Your Account Will Be Drafted Monthly After 1st Month)
| ||||
Autorización De Su Tarjeta De Crédito Para Los Pagos De Los Proximos Meses
For your Records
Double click here to add text.
PH: 1-800-370-7054
Fax: 407-851-7126
