ORDER FORM
 


 

Entire Package for
Only $1497.00 + $9.50 S/H

That's a savings of $350
                                                                                                                      

                                                                                                             

Please complete the information below to order your program

 

Billing Address

Company :
First Name :
Last Name :
Address :
Address 2 :
City :
State :   Zip :
Email :
Phone :
 

Shipping Address

Same As Above :  Yes    No  
First Name :
Last Name :
Address :
Address 2 :
City :
State :   Zip :
Phone :
 

Payment Information

Payment Type :
Name On Car/Account :
Card Number :
Exp. Date (mm/yy) :
CVV Number :
This is a 3 digit number on the back of a Visa and Mastercard or a 4 digit number on the american Express card.

Authorization

By my digital signature below I authorize you to charge the credit card, indicated above, for the purchase of the Bill Clark program: $1497.00 plus $9.95 shipping/handling.
Digital Signature :
Today's Date :
  Indicates Required Field