TName: ________________________________ SSN or TIN (required):_____________________
TAddress (No P. O. Boxes): _______________________________________________________
TDay Phone:____________________ Fax: __________________ Email: ___________________
I hereby authorize 20•20 to duplicate the attached check in bank draft form. I understand that I will retain my original copy
for my record of this transaction. I understand that the Payee or Authorized Agent of Payee will sign the bank draft as my agent
for this transaction only. This authorization is valid for this transaction only. No other bank drafts may be created without my
our direct written or oral authorization.
My signature below indicates also that I have read the policies and procedures and I accept the terms and conditions. I am
also aware that I am NOT required to make any purchase as a requisite to enter the compensation plan. I realize that I have
the right to Cancel at any time, regardless of reason and that if I cancel within 30 days, I may receive a partial refund.
Cancellation must be submitted in writing to 20•20.
TPRINT YOUR NAME: _______________________________________
TSIGNATURE (required): ___________________________ DATE: ________________
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