Seperate Enrollment Form
Separate Enrollment Form:
"YES. I wish to join the Private Gold-Mine Organization and increase my wealth tremendously.
I have completed the section below with my name, postal address and email address if available.
Please send the information on whom to purchase the Product from, and the Introductory Details to get me started with my Private Gold Mine.
I understand that after enrolling, I must still make my one and only purchase of one Product for the price of $15 or £10 or E15, before I can move into position to start receiving my $1,500,000 or £1,000,000 or E1,500,000 income.
I understand that I am under no obligation at any time other than to supply Product AFTER I receive payment.
ALL payments MUST be in US DOLLARS, BRITISH POUNDS or EUROPEAN EUROS ONLY. We prefer online payment by PayPal, StormPay or e-gold however we will accept cash in one of the three currencies if online payment is not possible or we will accept cheques in US Dollars. Cheques in any currency other than USD will be destroyed without comment.
"ENCLOSED is my $15 or £10 or E15 Enrollment Fee. I expect my membership documents within 7-14 days."
ENTER YOUR DETAILS BELOW:
Your address should be simple and clear. Include your full postal address, and email if available, CLEARLY so that you can be paid. (If you include your email address, this speeds up the process no end.)
"I want to receive over $1,500,000 or £1,000,000 or E1,500,000
Please enroll me in The Private Gold-Mine Organization:"
Name Mr./Mrs./Miss/Ms:.........................................
Full Postal Address:......................................................................................................
..............................................................
Post/Zip Code:............................................... Country:...............................................
Date:............................................................
Email: (If Available).............................................................................................
YOUR SPONSOR IS:
Bjorn Sandvar, 8035 Cooper Rd., Halfmoon Bay, B.C. V0N 1Y1, Canada, Phone: (604)885-2762, Email: karro@dccnet.com, Pay by: PayPal,Stormpay to karro@dccnet.com, E-gold acct: # 217932,
E-Bullion acct: # A64764
ORDER PRODUCT FROM:
Kevin Fadden, 7511 Main, Kansas City, MO 64114 USA, Phone: (816) 309-9706, Email: pgm@dysplaysia.com, PayPal & StormPay: paypal@dysplaysia.com, E-gold acct. # 670458, E-Bullion acct. # B20244.
For PRODUCT:
If possible, please pay Kevin Fadden by Paypal or e-gold or cash, checks may be sent to us in US Dollars. Checks should be made out for $15 to "Dysplaysia", please.
Post this form with your Enrollment Fee of $15 or £10 or E15 to your Sponsor. (Post to United Kingdom from the US takes no more than 2-3 days, 2 days from the Europe, and 3-4 days from Australia, New Zealand and the Far East. Or you can conduct the entire transaction over the Internet - see below.)
For your own benefit do write your details clearly so your money can reach you.
The only thing you can do wrong is not fill in the form clearly. If we cannot read your handwriting we will not be able to proceed with your enrollment, so please take care!
If you prefer to pay online with your Credit Card.
Please Use a Secure Server like:
PayPal, Stormpay, E-gold or E-Bullion.
If you don't have an account, it's Free to Join.
Click on Buttons Below!!
You may speed up the process by paying online right now.
Don't forget to email your enrollment form to karro@dccnet.com at the same time.(just copy and paste it into the email and fill it in). (You will be brought back here after payment.)
Credit Cards and eChecks accepted via PayPal:
The only thing you can do wrong is not fill in the form correctly, so please take care!
IF THIS ENROLLMENT FORM HAS NOT PRINTED OUT NEATLY