Application  

Please fill out this form and click print. If you don't have a printer you may hand write the application providing all of the information requested.

 

First Name:   

Last Name:  

Address:              

City:                

State:           AL AR AK AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY  Zip:

             Phone (optional):

             E mail (optional):

Where did you here about us?:

 Enclosed is $19.95  (  )*check    (   ) money order   (  )cash
* Personal Checks held 5 Days! 

By participating, I hereby certify that I am a resident of the United States of America, age 18 or older, and that I have read and understand the contents of this website including the disclaimer. I understand that this one-time processing fee covers, not only my first parcel, but every parcel thereafter received from 1200weekly.com

signature: _____________________________date: ________  

Print this page and mail it with check, money order or cash, payable to:            

J Spruce
P.O. Box 14418
Cleveland, OH 44114

---

home   -   paypal