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VIP Membership  

Please, submit this form, or print and fax us with a photocopy of your identifications as listed below, as wel as the front and back sides of your credit card in order to receive your password and VIP Member ID Number.
Or, if you would like, you can call or fax us, and the form will be mailed to you.

Date

Personal Information
Name
Social Security #
Home Phone
Home Fax
Home E-mail
Address
City
State
Zip
Country

 

Business Information
Company Name
Business Phone
Business Fax
Business E-mail
Company Address
City
State
Zip
Country

Copyright , 1997 International hookup Services. All Rights Reserved.
Do not duplicate, copy or redistribute in any form.
Last updated:March 10, 1997.