Tom Danley's "Message of the Month"

Subscriber Application

Name:________________________________________

Social Security #: _______________________________(For tax form 1099)

Mailing Address:________________________________

City:__________________ State:_____ Zip __________

Phone:____________________________

Sponsor ID_________________________   

Pay by bank draft, credit card, check or money order. Complete the appropriate payment form on the attached pages to make a monthly payment either by deduction from your bank’s checking account or credit card.

SPONSOR ID REQUIRED ABOVE! 

"Send $25 plus $10 for Start-up Kit"  

Mail this information to:

Tom Danley Companies
2850 FM 727
Jefferson, TX 75657-57

To Pay By Bank Draft 
Please Print

THE TRANSACTION DAY WILL BE THE 27th OF EACH MONTH.

I hereby authorize Tom Danley Companies to draft the designated account below for my monthly payment of $25.00, plus a $1.00 processing fee. Add one-time $10 fee for Business Start-up Kit.

Email Address:  _______________________________________

SPONSOR ID REQUIRED WHEN FILLING OUT THIS FORM!!!!!!

To Pay By Credit Card  
Please Print

Circle:   MASTERCARD         VISA

Name Card is Issued in: ________________________________________________________

Credit Card #:  ___________  ______________  ____________________

Expiration Date: ____________________________

I hereby authorize Tom Danley Companies to debit the designated credit card account for my monthly payment of $25.00, plus a $1.00 processing fee, on the 1st day of each month. Add a one-time $10 fee for Business Start-up Kit!



Signature _______________________________________ Date ______________       

Email Address: ___________________________________

SPONSOR ID REQUIRED WHEN FILLING OUT THIS FORM!!!!!!