application form
DESCRIPTION
CPC Application FormTRANSCRIPT
Sponsors User Name: _______________ Sponsors Name: ________________
Your Information: Email Address: ____________________________________
First Name : _________________ Last Name: ____________________
Address: _________________________________________________________
Suburb/City : ___________ State: ________ Post Code: ________
Country: _________ Phone Number: _____________ Birth Date:________
Your User Name (5 to 9 Characters) ______________ Password: _____________
If Paying By Credit Card MasterCard / Visa / Cash
Card Holders Name ____________________ Expiry Date ______________
Card Number ________________________________
VCN Number (3 Numbers On Back of Card) _________
Pack $390.00 USD [ ] or $195.00 USD [ ]
Signing this form you agree that:
• The above is your Sponsor • Your placement in the Company’s Genealogy can’t be changed once processed. • Yes . I understand my Purchase is Non Refundable
Printed Name _______________ Signature __________________