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FIRST NAME 
LAST NAME 
ADDRESS 
CITY 
STATE 
ZIP 
COUNTRY 
E-MAIL 
PHONE 
FAX 

PROGRAM TYPE

$200 PILL $1,000 PIL PLUS
 

QUICK START PROGRAMS AVAILABLE

$800 PILL $2000 PIL PLUS $1000 PILL/FREEDOM CARD

PILL/FREEDOM CARD PROGRAM - TERMS AND CONDITIONS

Participation in the PILL/FREEDOM CARD PROGRAM is optional. This program
includes a monthly fee of $30 deducted from the trust for payment of an
Internet web page.These funds are paid upline 4 levels at $5 per level.
PILL Trust members can participate in the program by introducing one
additional member at $200 and checking below. PIL PLUS Trust members
are already qualified and simply need to check below.
 

I understand the PILL/FREEDOM CARD PROGRAM and hereby authorize the monthly withdrawls from the trust account: 

SPONSOR ID # 

PAYMENT:

CHECK/MONEY ORDER AMOUNT 
CREDIT CARD MC/VISA ONLY(5% PROCESSING FEE FOR CREDIT CARD PAYMENTS)
CARD# EXPIRATION DATE