ORDER FORM
NAME__________________________________________________________________
STREET__________________________________ CITY OR TOWN__________________________
STATE______________________________________ ZIP CODE_________________________
E-MAIL ADDRESS_________________________________________________________________
PHONE NUMBER ( ) - ________ - ____________
Please check all that apply below
_____ Enclosed is my $10.00 for the Home Employment Information and Software Package. I am also
enclosing $1.50 for shipping and handling bringing the total to $11.50. I also understand that this
program is based on motivation and that individual results will vary and success is in no way, shape,
or form guaranteed. I also understand that if this program is not successful for any reason I am not
entitled to a refund due to the high number of "tire kickers"! I understand that if I am not motivated
to make money by working for it, I should not be ordering this program.
_____ Check here if you want to receive special offers and promotions from our affiliates.
_____ I have read and agree with all of the terms and conditions of this program.
signature___________________________________ date_____________
Please send completed order form along with check or money order to:
A. Bourget
14 Greenwood Street
North Smithfield, RI 02896
e-mail us at
All orders will be held until checks
clear.