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Transcript
MEMBERSHIP APPLICATION FORM
I subscribe to your SUPERRICHCLUB membership and its shopping mall services, and I have been fully informed and understood the policy that refunds for this membership and its digital products and services will not be provided at any circumstances.
Name : (Sign)
PRODUCT
POSITION USD POSITION USD
MEMBER $86 EMERALD $1000
BRONZE $100 RUBY $2000
SILVER $200 SAPPHIRE $3000
PLATILUM $300 DIAMOND $5000
GOLD $500 WHITEDIAMOND $10000
INFO
NAME PHONE NUMBER - -
E-MAIL @
USER NAME PASS WORD
ADDRESS
SPONSOR NAMEUSERNAME
2016 年 月 日
NAME : (sign)
www.superrichclub.biz
SUPERRICHCLUB