[Webinar Special] Elite 50% Broker Order Form

Client Information:

Your First Name *

Your Last Name *

Your Email Address *

Your Phone Number *

Who helped you?

Card Details

Agreed price to be charged on my card *

Credit Card Type *

Name on Card *

Credit Card Number *

Expiration Date (mm/yy) *

CVC (3 digit code) *

Billing Address *

Address line two (apartment #, etc.)

City *

State *

Zip Code (must match billing zip code or your card will decline) *

Financial Consulting Management Group (FCMG), 1015 Atlantic Blvd 86, Atlantic Beach, FL 32233.

I authorize Financial Consulting Management Group to debit my debit/credit card for consulting work. I understand this amount is non-refundable unless I request a refund in writing within the first 5 days of placing my order. By checking this box, I understand that there will be absolutely no refunds for this service/product unless I cancel within 5 days. By checking this box, I authorize FCMG to charge the listed amount for financial consulting services that are provided by phone and email. *

I understand

I authorize that this is my credit card, not someone else's *

I agree

No this is not my card

I authorize to charge my card for the amount shown on this agreement. *

I authorize this charge for this amount

I HEREBY CERTIFY THAT I HAVE READ AND AGREE WITH THE TERMS SET FORTH ABOVE. *

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