Quick-Start Premium Kit Order Form


United Refund Services
1236 Rio De Janeiro Ave. Suite E
Punta Gorda, FL 33983


I have enclosed my $34.00 payment in the form of a:

Personal Check ___ Money Order ___

Cashier's Check ___


Please send my Quick-Start Premium Kit to:


E-mail Address:

______________________________________




Make your own free website on Tripod.com