THIS IS A SECURED SERVER PAGE. YOUR DATA IS SAFELY ENCRYPTED AND IS SAFE FROM UNAUTHORIZED ACCESS.

All purchases must be made with a valid credit card - no checks or money orders accepted.
Providing this information constitutes your permission for Glazer-Kennedy Inner Circle LLC

to contact you regarding related information via mail, e-mail, fax, and phone.

If you prefer to fax in or mail in your order. Please print out this form and fax it to 410-825-3301 along with your credit card information or mail to: Glazer/Kennedy Inner Circle, 8600 LaSalle Road, Chester Building Ste 321, Towson, MD 21286

Also on the fax or letter please mention who referred you to this special.

Contact Information
First Name *
Last Name *
Title
Company
Email *
Work Phone *
Work Phone Ext
Home Phone
Mobile Phone
Fax Number
Lead Source
Notes
Birthday (mm-dd-yyyy)
Billing Address
Street Address 1 *
Street Address 2
City *
State *
Postal Code *
Country
Credit Card Information
Card Type *
Card Number *
Expiration Month *
Expiration Year *
Product Purchase Plan
Wealth Attraction Seminar-Video+Audio CD's/DVD+Seminar Manual-US&CANADA: Wealth AttractionAmt
1 Payment of $399.00
$399.00
Process

I authorize Glazer-Kennedy Inner Circle to charge me for the above total.
I further affirm that the name and personal information provided on this form are true and correct.

I further declare that I have read, understand and accept Glazer-Kennedy Inner Circle's business terms as published on the web site.

By pressing the ORDER button below, I agree to pay Glazer-Kennedy Inner Circle.

ORDER PROCESSING MAY TAKE UP TO 90 SECONDS.
TO PREVENT ERRORS, PLEASE CLICK THE ORDER BUTTON ONLY ONCE
.