ORDER FORM

"The Millionaire Mindset"

Please complete the form below and either post it back to me at my FREEPOST address (shown at the bottom of this page) or FAX it to me at 01924 800621

Please Fill in your Information Below

Please charge my credit/debit card Amex / Visa / MasterCard / Switch / Solo / Delta / JCB the sum of £67 (incl. £4.95 p&p and VAT)

Cardholder's Name (as it appears on the card):

_______________________________

Signature:

_______________________________

Expiry Date:

3 or 4 digit Security Code (on reverse of card above signature strip):

Valid From:

Card Issuer (eg. "Barclays" or "MBNA"): _____________________

Switch/Solo Issue No.:

OR

Please find enclosed my cheque/postal orders for £67 (incl. £4.95 p&p and VAT) made payable to JDS Product Developers.

Delivery Details

Date:

Mr/Ms/Mrs/Miss/Other:_______________________________

Name:_______________________________

Address:_______________________________

____________________________________

____________________________________

Postcode:___________________

Tel:________________________

Fax:________________________

e-mail:________________________________