Check/Money Order Form

Please Mail A Copy Of This Completed Form With Your Check Or Money Order To:

Homeworkers Network

2010 Crow Canyon Place, Suite 100

San Ramon, CA 94583

**Please Make Your Check Or Money Order Payable To: Homeworkers Network
Please keep a copy of your completed form for your records.

( )YES! I want to get started making money at home as a Name List Data Processor. I understand that this registration fee will be refunded after I submit my first 100 names and addresses. Enclosed is $39.95. Please also include my special FREE BONUS "Work At Home Jobs Resource Guide".

Name ______________________________________________________

Address ____________________________________________________

City _______________________________________________________

State _______________________________ Zip Code ______________

Telephone Number __________________________________________

Email Address (ie: johndoe@aol.com)_____________________________________________

Email Address Written Again For Verification _________________________________________

**PLEASE NOTE: We will send you an email giving you access to the Members Area once we receive your payment. Checks take an extra 14-21 days to clear.

Thank You For Your Order!