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Personal Credit Builder Purchase Order Form

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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. 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

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

January 31, 2016 10:32 pm EST

Personal Credit Builder Purchase Order Form Uploaded by Lorenzo Rodriguez - Supportlmr@LMRinternational.com IP 72.207.142.145