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Sponsor Copy- Online Registration Information
Name____________________________________________ Date of Birth____________ Address____________________________City________________State____Zip_______ Drivers Lisc. #___________________________ S.S.______________________________ Home Phone_____________________________ Cell Phone_______________________ E-Mail__________________________________________________________________ Checking Account Info or Attach a Check Name on Account_________________________________________________________ Routing #___________________________________Account #____________________ Check # Location: Right/Center (circle one) Bank Name__________________________ Credit Card Information (for PWP Setup) Name as on Card___________________________ Exp. Date______________________ Card #______________________________________Verification #_________________ Billing Address___________________________________________________________ City___________________________________State________Zip__________________ Selected Qualifying Services (3 Qualifying Customer Points) _____ Personal Web Site (PWP)--$19.95 per month (plus $19.95 set up) Password_____________________

_____True Essentials Mineral PH ($39.99 monthly) -Easy Ship=1 Customer Point
_____True Essentials Joint Solutions ($39.99 monthly) -Easy Ship=1 Customer Point
_____True Essentials Men’s Pack ($39.99 ea. monthly) -Easy Ship=1 Customer Point
_____True Essentials Women’s Pack ($39.99 ea. monthly) -Easy Ship=1 Customer Point
_____True Essentials Co-Q10 ($39.99 monthly) -Easy Ship=1 Customer Point
_____True Essentials Fruit & Vegetables ($39.99 monthly) -Easy Ship=1 Customer Point
_____True Essentials Hoodia appetite suppressant ($39.99) -Easy Ship=1 Customer Point
_____True Essentials Platinum weight loss system (216.99)=5 Points (Month supply of hoodia, protein shakes, appetite
control, fat blocker, fiber and energizer tea)
____True Essentials Gold weight loss system ($159.99)=4 points (protein shake, energizer tea, appetite control, fiber,
fat blocker)
____ True Essentials Silver weight loss system (113.99)= 2 points (Month supply of protein shake and energizer tea).

_____Fon-Vantage ($29.95 monthly +$95 one time setup fee; good quality broad band required) _____DISH Network (Check website for details- same packages & rates as all other Dish customers- no equipment charges) _____GE Home Security- $29.95 per month – FREE equipment & installation $19.95 per month (plus 19.95 set up) _____Fortune Health Care Card- $25 or more monthly plan _____Cell Phone (Family Plan with multiple phones = 2 pts.)- dozens of Free or discounted phones- same rate plans _____HomeVantage- Home or business phone- Local and/or LD (see PWP for details) _____IdentaShield- Identity theft insurance & free or discounted legal services ($15.00 one time sign up - $15.95 per month)


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