Higher Response Marketing, Inc.



"Explode Your Sales" Eclass Order Form

I authorize Higher Response Marketing, Inc to charge the total sum of      $1500.00 USD to my credit card noted below for my seat on this Eclass.

I understand the guarantee allows me to cancel my order after the first       lesson if I am not satisfied, as per Marlon's guarantee.

First/Last Name:
Phone Number:
Fax Number:
Email Address:
Verify Email Address:
Credit Card Number:
Expiry Date:    
WRITTEN SIGNATURE: ________________________________

Do you have a web site?

Yes
No

If Yes, what is the URL?_____________________

What other marketing information have you bought?

___________________________________________

___________________________________________

What is the #1 thing you want to gain from the Explode Your Sales E-Class?

____________________________________________________

What is the #2 thing you want to gain from the Explode Your Sales E-Class?

____________________________________________________

What do you want to avoid by purchasing the Explode Your Sales E-Class?

____________________________________________________

How much can you spend monthly on marketing?

____________________________________________________

Do you have a customer list?

Yes
No

If so, how large is it? ____________________

What are your annual sales? ______________

Total # of customers? ___________________

PRINT THIS FORM AND FAX TO: 1-250-748-1041