Pot of Gold

NETHERLANDS

JISL CHRONICLE

-Subscription Application-

A $5 GIMMICK

Print clearly by hand (Black Ink Only) or affix a printed label in the boxes if you have one.

Name__________________________

Address____________________________

Town/City______________________

State/Province_______________________

Postal/Zip Code_________________


Country_______________________

Phone # ___________________________


Fax: ______________________________

Email Address_________________________________________________
The applicant wishes to subscribe to the JISL Chronicle. The applicant wishes to participate in the 3 X 11 matrix and authorizes JISL to settle -if possible- monthly payments with the proceeds of this matrix. ALl commissions are based on the $5.00 sale of the JISL Chronicle. Applicant will receive the "JISL Access Card" as soon as the total of the proceeds of the matrix exceed the net amount of $100.00 US (if applicant is paying for more positions in the universal matrix, all those payments and proceeds will count towards the amount). On dispatch of the card, JISL will deduct $35.00 US (thirty-five American dollars) from the applicant's balance as the 1st. annual fee for the card. The card allows each participant access to his/her money from ATM machines all over the world which display the CIRRUS logo.

Date:_______________

No signature required because you are under no obligation whatsoever.

Sponsor: Jack Bowman

               Pin #:N2BS201AG91

 

Option 1:

Send this application form, an International Money Order (payable to: World Wide Marketing), and a long self-addressed stamped envelope to:

World Wide Marketing
1020 Hargrieve Road, Unit #4
London, ON, Canada N6E 1P5
[ ] First Subscription ("under your sponsor")
[ ] Number of Re-entries
in the Universal Matrix
+ Shipping and Handling.

@ $7.50 CDN or $5.00 US

@ $7.50 CDN or $5.00 US each =
@ $2.50 CDN or $1.50 US
Total Amount Enclosed

World Wide Marketing is an Independent Re-Mail Service

$__________

$__________
$__________
$__________

Option 2: Pay by Credit Card
[ ] Visa
[ ] MasterCard
[ ] AmEx


(Print) Card Holder's Name

Credit Card # _________________________

Expiry Date ________________


___________________________________


Date________________ Authorized Signature _________________________
[ ] First Subscription ("under your sponsor")
[ ] Number of Re-entries
in the Universal Matrix

@ $5.50 US

@ $5.50 US each =

Total Amount

$__________

$__________

$__________
Send this application form to:
Or fax to:		 FDG, P.O. Box 6403, 5600 HK, Eindhoven, Netherlands
(011)+31-40-2459518