______ Yes, Mark, Sign me up for the Reverse Real Estate System NOW for only $897.00 for taking action today. I also understand that my charge card will be billed today for the amount stated.
 

Name on card:_______________________________________________Email______________________________________

Address:__________________________________________________________________________________________________

City/State/Zip:__________________________________________________________________________________________

Card #_________________________________________Exp date____________________ 3 digit code on back____________

Phone # _______________________________________ fax#______________________________________________________

Credit card        Visa                 MasterCard                          American Express

Signature___________________________________________________Date__________________

 

**Providing this information constitutes your permission for Mark Evans DM LLC to contact you regarding related information via fax, mail, email, and phone. Also you're agreeing that Racine Assets LLC has permission to charge the agreed amount stated above with the terms stated above.

Mail This Form To:

Mark Evans DM
4719 Reed Rd. #325
Columbus, Ohio 43220

Copyright © 2006 Racine Assets LLC All rights reserved.