Order Form

AdPayUSA
ORDER FORM

Get Paid Every 48-Hours!
Earn up to $500.00 on a SINGLE Sale!
Only two sales will bring you:

IMPORTANT NOTICE: PLEASE PRINT THE NAME OF THE PERSON YOU WANT YOUR COMMISSION CHECKS MADE OUT TO BELOW UNDER YOUR FULL NAME:

YES DALE! I want to be one of the first dealers to cash in from your all new and exciting AdPayUSA Program! Email me my Electronic version information so I can get started IMMEDIATELY and also mail me my PRINTED Dealership Kit via U.S. PRIORITY MAIL AT NO EXTRA COST! Below is my payment information for only $112.00. I understand there are no other costs (ever) associated with this program and that you will build my customized money making website and pay for all the hosting costs of my site.

*Email
*Your Full Name
Company Name (if any)
*Billing/Shipping Address
*City
*State
*Zip Code
*Phone Number

*Credit Card Number:
*Expiration Date
*License Type?
* Required Fields You must agree that you are submiting this form for consideration to be a Licensed AdPayUSA Dealer and agree all sales are final. Your one time fee includes hosting of your site. No spamming to promote your site. Income projections are for illustrative purposes only. Your own income will depend on the marketing methods, time and efforts you put into the program and there is no income guaranteed. You understand you are responsible for all taxes on income earned from this program. You agree to these terms by typing YOUR FULL NAME in the below box,
Your Full Name:

AdPayUSA - UNIVERSAL $ERVICES
P.O. Box 2440 - Midland, MI 48641-2440
Doing Business At The Same Address For Well Over Ten Years!

Questions? Email us at: universal-services@charter.net

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