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Application
I WISH TO PRE-ENROLL FOR $2
I WISH TO JOIN AT STAGE 1 $19
I WISH TO JOIN AT STAGE 2 $29
I WISH TO JOIN AT STAGE 3 $39
 NAME___________________________________________________

Address__________________________________________________

City________________________St/Prov________Zip Code_________

Phone/FAX_______________________________Sponsor Id# P4277

      I wish to pay by         Cash   Check   Money Order   Visa   Mastercard

I understand that I will receive a company          Card Number_______________Exp.Date________
Starter Kit upon officially joining Power-Net III    Name(on card)_____________________________
                                                                 Signature(of card holder)______________________

Print This Application! Mail it & all payments to: JRS Printing, P.O. Box 180, Vanceboro, ME 04491
Phone (506)366-5832 FAX (506) 366-5840 Fax on Demand: 330-697-0777 Doc 04491

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