Ref: [esigIDfield]
Personal Credit Builder

LMR International, Inc.
Credit Card Authorization Form

Cardholder Name:   

Credit Card Number:  CVV2  (Code on back) Exp Date:  

Billing Address: 
 
City:  State:  Zip Code:   
(Address where monthly Credit Card statements are received)

Phone Number:   
(Associated with Credit Card)

E-mail:   

Being the cardholder or Corporate Officer, by signing below I understand and agree to the terms set forth in this agreement, agree to pay, and specifically authorize LMR International Inc. to charge my Credit Card, for:

(mark with an X the option you want to purchase)

[ ] One Personal Credit Builder at $199.97

Comments:  

THIS SALE IS FINAL. I certify under penalty of perjury that I will not do a chargeback on any payments I make under this contract. A REFUND REQUEST WILL NOT BE HONORED. ANY ISSUES MUST BE RESOLVED BETWEEN THE PARTIES. LMR INTERNATIONAL, INC. WILL DO ITS BEST TO PROVIDE REASONABLE REMEDY AS APPROPRIATE.

Signature Date:

3750 Galt Ocean Drive #1511 , Ft. Lauderdale, Fl. 33308-7638
Phone: (800) 713-0457 Fax (800) 708-0365