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MembersNetwork Membership & Purchase Application

Part 1 -----------------------Membership Purchase------------------------		Amount Due
YES, I want to join as a Member and Purchase the Benefit Package. I understand this membership costs $197.00 annually (a $349.00 value). I understand once I join, I will receive my Visa Paycard and all the Membership Benefit Programs in my own private Back-Office website.		$197.00
YES, I want to join as a Reseller Member and start selling Memberships. I understand this membership costs $24.97 per month and I will be provided with my own Personal Selling Website, Back-Office, Online Training, Commission Reports and much more. I understand and agree that all future monthly payment will be charged against my Visa PayCard. (Special Note: You will be billed every month on the same day that you joined, you may cancel your monthly membership anytime within 72 hours of your next billing & your Personal Members Network Site will be removed.)		$24.97
YES, I would like to purchase a position in the company "Rotator" for $100 annually.		$100.00
YES, please send my Visa PayCard 2nd Day Air. I want it to arrive in 4 to 5 days instead of 7 to 10 days.		$7.00
YES, I waive my rights to "Customer Notice of Cancellation". Specifically,you may cancel this transaction without penalty or obligation within three (3) business days (Alaska residents five days) from the date of signing of this application.
Total Amount I am Sending:
ALL PAYMENTS MUST BE MADE PAYABLE and SENT TO: Members Network, LLC, 4800 N Federal Hwy. Suite A-208, Boca Raton, FL 33431. WE ONLY ACCEPT MONEY ORDERS OR BANK CHECKS. (Credit Cards or Personal Checks are Not Accepted as ship out the Visa PayCard immediately and pay commssions every Friday)

Part 2 --------------------------------- Your Marketing Team-------------------------------------

The list below are the Members in your Marketing Team. When you receive your Personal Website page, your name will be in the Your Referring Member spot. Until you receive this page, you cannot begin to Refer new members.

YOUR REFERRING MEMBER
Member Display Name: Lawrence The Magnificent
Member Name: LR001

POSITION #1
ID: RA178
Name: Rebeca A.

POSITION #2
ID: HR179
Name: Harold Walter

POSITION #3
ID: LM180
Name: Loredana Marinucci

POSITION #4
ID: SM181
Name: Silvana Montes

POSITION #5
ID: ET182
Name: Elena T.

Part 3 ----------------Fill-out your Members Network Application---------------------


*Affiliate Informatio n ( = Required Fields)**
First Name:	*(John - Use Upper & Lower Case)
Last/Family Name:	*(Smith - Use Upper & Lower Case)
Name to be Displayed on Your Site:		*This is the NAME people will SEE on your personalized membersnetwork.com website. (Please use Upper & Lower case.)
Company Name:
Address:	*
Address 2:	*
City:	*
State:	*
Zip/Postal Code:	*
Country:	* (at this moment it is only available in the USA)
Contact Phone:	*(312-333-1234)
Contact e-Mail:		* (for all Members Network correspondence)
Social Security:		* (to comply with the Patriot Act to be able to receive your Visa PayCard)
Date of Birth:		* (to comply with the Patriot Act to be able to receive your Visa PayCard)
Special e-Mail Note:	Your email address must be valid. Upon completion of your registration, you will receive an email with your Username and SECRET Password, so you can login to your new Members Network Reseller account.
You MUST Fill-in Your Payment Accounts ( you need at least one to get PAID )

PLEASE READ & CHECK BOXES!

By checking this box, I have read and agree to Members Network's Terms & Conditions

By checking this box, I agree to the terms in the Spam Policy:

By checking this box, I agree that Members Network wil debit/credit my Visa PayCardt every month to pay for Membership until I cancel.

PLEASE NOTE: Members may not use unsolicited email, also known as "SPAM" to promote membersnetwork.com in any manner. Any Member who violates this policy will be terminated immediately and will lose his/hers entire Members Network Group.

THIS FORM WILL BE SENT ON A SECURE SERVER!
(This may take a few minutes)

The next page you see will be our "THANK YOU". You will receive an email within 24 - 72 hours with your Personal Website, Private Back-Office and SECRET PASSWORD.

DO NOT PROMOTE YOUR WEBSITE UNTIL YOUR NAME IS IN THE TEAM MARKETING LIST NUMBER 1 POSITION!

If you have any questions, contact us at: support@membersnetwork.com

Clicking the Submit Button indicates that you have carefully read this Agreement and that you willingly accept all the Terms and Conditions.

ONLY CLICK THE SUBMIT BUTTON ONCE!

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