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Welcome from the Offices of Gas and Cash and New Car Mania

I want to welcome you to the Gas Club family and assure you that you are joining a growing, 1 year old company that carries a reputation of integrity and credibility in the industry. For more than 1 years, Gas and Cash has been coming to the industry with a unique and cutting edge product . Whether your goal is to improve your income, or help us clean up the Earth Gas and Cash has a natural solution to meet your needs. Gas and Cash also provides one of the most creative compensation plans that reward your efforts with both immediate and long-term residual income

Total Cost of Our Plan $150.00
Fill in your Enroller's Information
Enroller ID#
Enroller Name
New Associate Information
*Note - denotes a required field**
First Name	*
Middle Initial
Last Name	*
Company Name
Note - If Company Name is Included Company Name Will Appear on All Bonus Checks
Social Security # No Federal ID	*
Note - This field is required if you live in the United States

Mailing Address
Street Address	*
Address 2
City	*
Country	*
State	*
County
Zip	*


Copy the shipping address above
Shipping Address (if different than above)
First Name	*
Middle Initial
Last Name	*
Company Name

Street Address
Address 2
City
Country	*
State
County
Zip

Contact Information
Day Phone # (Business)	*
Night Phone # (Home)
Fax #
Note - #?Please use only dashes between numbers...972-548-2500

e-mail address	*
Re-enter e-mail Address	*
Password	*
Re-enter Password	*

List Your Method of Payment

Set up your method of payment for your first order (if applicable), e-Biz Center (if applicable) and Back Up Order. This will make the ordering process in the future much easier. You must have a method of payment on file for future orders. You will be able to change your method of payment at any time in the future.

Name on Card

Type of Card

Card Number

Expiration Date

Card Verification #

YOUR CARD VERIFICATION NUMBER IS YOUR ADDITIONAL PROTECTION -- to ensure your credit card information is not being used fraudulently.
	For your safety and security please provide the 3-digit validation code. This is the non-embossed number printed on the signature panel on the back of the card immediately following the Visa, MC or Discover card account number.

Statement Address (If different from the Address You Previously Entered)

Street Address
Address2
City
Country
State
Zip

I agree that this information is confidential and will be kept on file by Gas and Cash, only for the purpose of payment for any product or sales aids purchases authorized by me. I understand that I can change my method of payment or add additional method of payments at any time.

I authorize Gas and Cash to charge my method of payment for my order.