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Britt Phillips' Coastal Vacations Sign Up Form

Which way are you joining the program? Check your answer...
___ "Ultimate Buy In" - $24,000.
___ "Platinum" - $11,000.
___ "Buy In" - $10,000.
___ "Premier" - $3,995.
___ "Level One" - $1,500.
___ Consulting + 3 Ad Coop Shares with FREE Biz & Retail Web Sites - $2,000.
___ Consulting - $1,000. 30 Days
___ Consulting - $5,000. LIFETIME


Name: _____________________________________

Physical Mailing Address:

_________________________________________

_________________________________________

_________________________________________

Home Phone: ______________________________

Office Phone: ______________________________

Cell Phone: ________________________________

Do you want to participate in my 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 the form of a cashiers check, certified check, or money order. If you are outside of the USA, you must include an international money order. Please do NOT staple your payment to this form.

Please send for next day early morning delivery by FedEx or UPS.
Please make payment payable to:
Worldwide Ad Network, Inc.
14241 Midlothian Turnpike, #106
Midlothian, VA 23113-6500

804-897-2274