"Fax-Mail Order Form"

Print this page, fill it out and:

• FAX to:    eBusiness Power, Inc   at  253 498 7382

or
• MAIL to:
  eBusiness Power, Inc
  ATTN: Jim Eastman
  81 Lumley Avenue
  Ft. Thomas, KY 41075
  

Yes Ben! I want to quickly get my credit back on track and I want instant access to your eBook and bonuses. I understand that your eBook comes with a 100% money back guarantee.

On that basis, here's my order:

Choose Package:	Basic Package $29.00 Gold Package $37.00
First Name: (as it appears on Credit Card or check)
Last Name: (as it appears on Credit Card or check)
E-Mail:
Type of payment:	Credit Card Check or MO
Credit Card Type: (if paying by credit card)	Amex Bravo Discover Euro Card MasterCard MC Debit Novus Visa Visa Debit
Credit Card #:
Validation Code: (3 or 4 digit # on back or front of card)
Credit Card Expiration:	Month: 01 02 03 04 05 06 07 08 09 10 11 12 Select... Year: 2002 2003 2004 2005 2006 2007 2008 2009 2010 Select...
Street Address: (as it appears on Credit Card)
Street Address (line 2):
City:
State:
Country:
Zip Code:
Telephone (w/area code):

*** Note: Be assured that faxes come directly to my computer and would not be viewed by anyone else.

- I hereby authorize eBusiness Power, Inc to charge my credit card as indicated above. In return I will receive by eMail a link to the download area to receive my eBook, bonuses and additional reports (if purchased).

- The merchant name on your credit card statement will be Authorize.Net

- Checks will take an additional 10 days from receipt to clear.

- Once you print this form, please sign your name below

Signature: ________________________________________