KwicTax Application Form

KwicTax LLC

KwicTax Application Form

Sign me up...I'm ready to take back control of my business AND my life

KwicTax Application Form

To apply for KT Membership and begin your journey towards bigger profits and business success, print this form, complete and fax back to KwicTax LLC at

(845) 615-1064.

Membership Option #1 - President

Payment Options - Choose One

____Annual $9,997 (Save $1,967)

____4 Payments per year - $2,750

____Monthly Payments of $997

Membership Option #2 - Executive

Payment Options - Choose One

____Annual $4,500 (Save $540)
____4 Payments per Year- $1,175
____Monthly payments of $420

Membership Option #3 - Business Owner

Payment Options - Choose One

____Annual $3,700 (Save $360)
____4 Payments per year- $950
____Monthly Payments of $339

Name ______________________________________

Company Name ______________________________

Address ______________________________

City _____________________________________

State ___________________________________

Zip Code________________________________

Phone __________________________________

Fax ____________________________________

Email ___________________________________

Credit Card Information - Visa or MasterCard

Credit Card # _____________________________

3 or 4 Digit # ______________________________

Expiration Date ____________________________

Signature ________________________________

Today's Date _____________________________

_____No thanks, but please send me my FREE 3 month subscription to The KT Gold Mine for only $6.95 to cover the costs of shipping and handling. I understand that my credit card will be billed after the 3 month trial period has expired for the monthly subscription price of $29.97. I have the option of cancelling at anytime by notifying KwicTax by e-mail, telephone or fax.

1787 Route 17M * Goshen, NY 10924

Tele: (845) 615-8550

Fax: (845) 615-1064

e mail: info@kwictaxllc.com