Coastal Vacations Sign Up Application - Thanks - Welcome to the team!

Which Start Up Option Do You Choose?
___ "Ultimate Buy In" - $24,000.
___ "Platinum" - $11,000.
___ "Buy In" - $10,000.
___ "Premier" - $3,995.
___ "Level One" - $1,500.
___ Consulting (Lifetime) - $5,000.
___ Consulting (30 Days) - $1,000.

Name: _____________________________________

Physical Mailing Address:

_________________________________________

_________________________________________

_________________________________________

Home Phone: ______________________________

Office Phone: ______________________________

Cell Phone: ________________________________

Do you want to participate in our National Advertising Coop? YES or NO
How many shares in the coop would you like?

___ 3 Shares - $1,000. (save $200.)
___ 2 Shares - $750. (save $50.)
___ 1 Share - $400.

Don't forget to include payment in form of a cashiers check, certified check, or money order. If you are outside the USA, you must include an international money order. Please do NOT staple payment to this form. Please send next day early morning delivery by FedEx or UPS. Please make payment payable to and send to:

Worldwide Ad Network, Inc.
14241 Midlothian Turnpike, # 106
Midlothian, VA 23113

I wish to clearly and conspicuously disclose the generally expected performance in the depicted circumstances. My results are extraordinary. You should not base your decision to join this, or any business opportunity, solely based upon my own, or any other testimonials. You should look at the compensation plan, marketing system, available training, tools and resources. Your results may not be the same. As with any opportunity, you could earn more, less, or nothing at all. You should do your own due diligence before making a decision. 95% of those who join any business opportunity fail to make money with it, because it requires time, energy, implementation of strategies, the ability to set goals and focus on achieving them with consistent effort. You must be willing to do what most people aren't, if you expect to have results. I realize this is common sense but I have to include it for those who don't know this basic stuff!

Signature _________________________________________ Date ____________
I have read this statement. I agree that I am not being promised or guaranteed income.

This application must be signed and dated to be accepted. This application must be included with payment. Call Britt at 804-897-2274 with any questions.