Order Form

Coastal Vacations Purchase Order ... COMPLETE AND PRINT

Ship to: (Please Print or Type)

Presented by:

Name

Address

City

State

ZIP

Phone

PACKAGE
PRICE

QUANTITY

TOTAL

Level 1: The Coastal Vacation Package

$1,295 x

Level 2: Three Day Seminar on Finance, Motivation

$3,500 x

Premier Package: Combination of L-1 and L- 2 together. Save $800!

$3,995 x

TERMS and INSTRUCTIONS: Complete and mail in this form with a cashiers check or money order in full. You may also email it by clicking "Send", and your Coastal Director will contact you to arrange payment. Or, fill it out and click "File" then "Print", and fax your print-out of this form through a standard fax machine (See Contact page for number). Alternatively, you may log-off the internet and fax this page through your fax/modem by clicking "File" then "Print" and then selecting your fax/modem as your printer and following your computers instructions from there.

SUB-TOTAL:

Freight:
UPS $10
FED EX 2nd day air $25

BALANCE DUE:

Name on Card: _________________________ Billing Address: ________________________________________

Card number: _____________________________ Expiration Date: ______________

CARD CONFIRMATION NUMBER ON BACK OF CARD (last 3 digits): XXXX XXXX XXXX XXXX 000 -____________

MONEY-BACK GUARANTEE! Qualified Sales Associates offer a money back guarantee for the Level 1 Coast Club Vacation Package, the Premiere Package, and the Platinum Package. If, after reviewing our incredible packages, and the customer feels he/she has not received exceptional value, the materials may be returned in reusable condition within ten days from whom the product was purchased for a prompt refund.

PACKAGE	PRICE	QUANTITY	TOTAL
Level 1: The Coastal Vacation Package	$1,295 x
Level 2: Three Day Seminar on Finance, Motivation	$3,500 x
Premier Package: Combination of L-1 and L- 2 together. Save $800!	$3,995 x
TERMS and INSTRUCTIONS: Complete and mail in this form with a cashiers check or money order in full. You may also email it by clicking "Send", and your Coastal Director will contact you to arrange payment. Or, fill it out and click "File" then "Print", and fax your print-out of this form through a standard fax machine (See Contact page for number). Alternatively, you may log-off the internet and fax this page through your fax/modem by clicking "File" then "Print" and then selecting your fax/modem as your printer and following your computers instructions from there.		SUB-TOTAL:
		Freight: UPS $10 FED EX 2nd day air $25
		BALANCE DUE: