New EXCEL Retirement Snapshot

Application Form

___ Yes, I want to take control of my financial future and purchase the Retirement Calculator for a one-time fee of $69.99.

I Will Receive A Free Bonus Gift As Follows:

When you order your very own Retirement Snapshot I’m going to give you an audio version of the highly acclaimed 20/20 Wealth Vision Program.

The Free 20/20 Wealth Vision Program is a $495.00 value that’s your free.  Just one simple concept from this program helped me to make over $50,000 in a single month and can do the same for you.

STEP #1:

__  FULL PAY One-time fee of $69.99

STEP #2: Fill Out Payment Instructions.

__Check

__Credit Card  ____ Visa  ___ MasterCard   ___ Discover  ___ American Express

Credit Card Number_________________________________________ Expires_________

Your Name_______________________________________________________________

Business Name____________________________________________________________

Address__________________________________________________________________

City/State/Zip Code_________________________________________________________

E-mail Address____________________________________________________________

Daytime Phone Number_____________________________________________________

STEP #4: Rush Your Acceptance Form to Us Fast.

Mail To:   GoldMine Web Design, LLC             Fax: 316-838-5353                Call Toll Free 877-207-9900

                 2020 W. 21st St. #96

                 Wichita, KS 67203