APPLICATION FORM FOR OUR GIFTING PROGRAM

Step 1: Using BLACK ink, completely fill out this application form, including providing us with a numerical 4-digit "Personal Security Password". The Personal Security Password is something that only you and we will know... it will not be released to anyone else. It will be used to positively identify you when you make changes to your personal information. Please PRINT VERY CLEARLY so that we can easily read all information once it has been faxed to us. (Fax transmissions cause loss of quality and clarity!) You do not have to use your real name if you don't want to... you may use any name you wish, but be sure that you can receive mail under whatever name you give us! We must have an accurate address within the U.S.

Step 2: Fax this application to our toll-free number: 1(866) 777-7788. Yep... we even pay for the phone call! These days you can find any number of places to send faxes for you... your local grocery store, a mail room, a print shop, Office Depot, Kinko's, Staples, or perhaps you have your own fax machine at home. With us paying for the call, even your employer shouldn't mind you sending a one-page fax from his machine since there's NO expense to him. (Sorry, but we will return or ignore any improperly completed applications.)

IMPORTANT! So that the sheet doesn't jam in your fax machine, please fax the whole page to us. If you cut this sheet you might have feeding problems which would make it difficult for us to read your application on our end and we won't be able to respond back to you. So please just fax the whole page to avoid any problems.

Your Name (Be sure you can
receive mail under this name):

Your Address
(U.S. only):

Your City,
State & Zip Code:

Your Telephone Number
(with area code):

4-Digit Numerical Personal Security Password
(YOU pick any 4-digit number you want):

These fine people on the list below are already beginning to improve their financial status.
YOU can add your name to this list and improve your financial status, too by joining us!

#1: xxxxxx
#2: xxxxxx
#3: xxxxxx
#4: xxxxxx
#5: xxxxxx
#6: xxxxxx

PLEASE TAKE NOTE!

If you have any problems getting through to the toll-free fax number listed above, or the alternate number, call our Fax-On-Demand number at 1(703) 834-8994 and, when prompted, enter Document #630 to receive any updated information. (You must be calling from a fax machine with a handset so that you can hear and follow the instructions you will be given when you call.)
At this time, because of the nature of us sending you your payments in U.S. dollars, we are only offering this program to people with an address located in the USA and its territories; if you live outside of the USA, you may participate, but you MUST give us a U.S. address where we can send you your cash payments and correspondence (use a friend or relative's address who lives within the U.S. if you need to). Absolutely NO cash payments will be made outside of the United States at this time.