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| Name: _________________________ |
| Email: _________________________ |
| Company (optional): ______________ |
| Addess: ______________________ |
| City: __________________________ |
| State: __________ |
| Country: ____________ |
| Zip: _________ |
| Phone: (___) ____- ______ |
| ( ) I am enclosing a check or money order for $375,00.
Please note that we do not accept checks by fax, so if you are paying by check
or money order you must mail it in to the address above. "Please make checks or money orders payable to the "MILETO ROBERTO" . |
| ( ) I want to charge this purchase to my Credit Card |
Credit Card (check one):
| VISA | ||
| MasterCard | |
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| American Express | |
|
| Discover |
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Card Number: _________________________ Expiry Date: _______ |
Signature: _____________________________
I authorize the Mileto Roberto Marketing Trading Center® to charge $375,00 to my credit card for the purchase of the "Email-Tec Investing OnLine "(24 month)