Fax or Mail Order Form
Please print the form first and then fill it out.

Date: _____________
I would like to order ___ copy(ies) of Potty Training Made Easy, Simple & Fast
 

(Please write very clear)

First Name ____________________
Last Name ____________________
Address ______________________
City _________________________
State_________________________
Country ______________________
Postal/Zip Code _______________
E-mail address ____________________@____________
Phone including area code __________________
Card (VISA, MasterCard, AMEX only)
Card Number ___________________________
Expiry Date __________________________
Exact name shown on card ________________

In order to purchase the above product, I hereby authorize 1st Advantage Solutions to bill my credit card, and agree to pay to my credit card company, the amount of $7.00.

Credit card authorization: ______________________
Signature _________________________
 

I would also like to order __ copy(ies) of the laminated potty charts and stickers for and additional $13.95+2.95 shipping and handling.  Please enter the number of copies you want in the space provided.  Enter 0 if you already have potty charts and don't  need any.

I understand that you will send my product via email when you receive this order. If I ordered the potty charts then they will be shipped via regular mail

I understand that I am completely protected by your 90-day money-back guarantee. If the product does not completely delight me, I will return it within 90 days and you will give me my money back.
And, I get to keep all the bonuses just for trying Potty Training Made Ease, Simple & Fast.

Please Fax this form to 270-596-8033

Please Mail check or money order to (we accept checks from US Locations only)

1st Advantage Solutions/Johanne Cesar
1025 Veterans Memorial Hwy
Suite 310-264
Mableton, GA 30126