Request for Information

Please complete the form below and You will receive
the first of 6 CD “12-Months to a MILLION” home study
course absolutely free to preview for 30-days in the
privacy of your home. Like the web page stated… All we
ask today is that you help us cover the Shipping and
Handling fee of $9.95. We accept Visa, Master Card,

In a few days you will receive “12-Months to a MILLION!”
and it’s yours free to preview for a full 30 days. If you do
not decide to keep it- just send it back and you’ll owe us
nothing more. The free trial was absolutely free. But on
the other hand… If you decide to keep it at the end of
your 30 day trial period, your credit card will be billed just
one easy installment of $197.

Checks and money orders most be for the full course $197.
Send to: Dr. Laurence Galant, 12077 Colony Preserve Drive,
Boynton Beach, FL 33436,

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First Name *
 Last Name *
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Contact Phone *
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How did you hear about the 12 months to a million Course?
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Methode of Payment
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3 or 4 diget security number, back of your card *
Name on Card *
Comments
 12 Months to a Million
 Your Wish Is Your Command

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