Fax or Mail Order Form
Please print the form first and then fill it out.

Date: _____________
I would like to order ___ copy(ies) of Potty Training Made Easy, Simple & Fast

First Name __________________
Last Name __________________
Address ____________________
City _______________________
State_______________________
Country ____________________
Postal/Zip Code _____________
E-mail address ______________@_________
Phone including area code ________________
Card (VISA, MasterCard, AMEX only)
Card Number _______________________
Expiry Date ________________________
Exact name shown on card _____________

In order to purchase the above product, I hereby authorize 1st Advantage Solutions to bill my credit card, and agree to pay to my credit card company, the amount of $27.
Credit card authorization: ______________________
Signature _________________________

I understand that you will send my product via email when you receive this order.

I understand that I am completely protected by your 90-day money-back guarantee. If the product does not completely delight me, I will return it within 90 days and you will give me my money back.
And, I get to keep all the bonuses just for trying Potty Training Made Ease, Simple & Fast.

Please Fax this form to 270-596-8033

Please Mail check or money order to

1st Advantage Solutions/Johanne Cesar
1025 Veterans Memorial Hwy
Suite 310-264
Mableton, GA 30126