Stud Secrets - SPECIAL OFFER - Fax Order Form



Please print this form, enter the required information and fax to:

Austin Research Order Processing Department
(410) 374-8087



COST FOR MEMBERSHIP

  The cost for complete online access to the Stud Secrets Program PLUS the (4) other sites
   included in our SPECIAL OFFER is just $ 149.97.  This is a one-time cost.

  You will receive full access to:  massivemember.com, orgasmmastery.com, betterejaculation.com,
   studsecrets.com, advancedseduction.com (5 sites total)


BILLING INFORMATION

  FULL NAME: ____________________________________________________

  BILLING ADDRESS: ______________________________________________

  CITY, STATE, ZIP: _______________________________________________

  COUNTRY/PROVINCE: ___________________________________________

  TELEPHONE NUMBER: ___________________________________________


  Note: Billing name and address must match the information on your credit card account exactly or it may not be accepted.


FULFILLMENT INFORMATION

  NAME: ____________________________________________________

  EMAIL ADDRESS: ____________________________________________

  EMAIL ADDRESS (REPEAT): ____________________________________

  Note: Your information will remain completely confidential and will not be sold or given to anyone.


CREDIT CARD INFORMATION

  SELECT CARD TYPE:             VISA     MASTERCARD     DISCOVER     AMERICAN EXPRESS

  CREDIT CARD NUMBER: ________________________________________________________

  CARD EXPIRATION DATE: (month/year) ___________________________________________

  CVV2 or CID (3 or 4 digit security code): __________________________________________


   IMPORTANT: THE SECURITY CODE IS A REQUIREMENT. WE MUST HAVE THIS CODE IN ORDER TO PROCESS YOUR ORDER.

   VISA/MC/DISCOVER:  Visa, MC and Discover all use 3 digit codes located on the back of the card, following the credit card number.
   AMERICAN EXPRESS: American Express uses a 4 digit code located on the front of the card, separate from the credit card number.


  ORDER AMOUNT:                                                                          $ 149.97

  TOTAL AMOUNT: (order amount)                                         $ _____________________


CUSTOMER AUTHORIZATION

I hereby certify that I am the authorizing card holder of this account. I understand that I will be billed for the total amount calculated above. I understand that the name appearing on my credit card billing statement will be either "Austin Research Institute via InternetSecure" or "PAYPAL AUSTINRESEA".


  CARDHOLDER SIGNATURE: ___________________________________________

  This text must be present on order form:         




PLEASE FAX THIS COMPLETED FORM TO (410) 374-8087

A receipt will be e-mailed to you immediately upon credit card approval, and
your usernames and passwords will be sent via e-mail as well. Thank you.

Copyright © 2001 - Present. Austin Research Institute. All Rights Reserved.