Ten-Ten International Net, Inc.

Application for Lifetime Membership



NAME: ____________________________________________ 10-10: ______________ CALL: ________________


ADDRESS: _____________________________________________________________ APT: _________________


CITY: ____________________________________________ STATE: ______________ ZIP: __________________



Check one of the following Life Membership categories, and circle Payment plan

Plan ID

Plan 1

Plan 2

Plan 3



Payments

1

1

2

1

2

3

4


US-Life

$500

$260

$250

$130

$130

$125

$125


DX-Life

$650

$335

$325

$170

$170

$160

$160


US-Senior Life

$150

$85

$75

N/A

N/A

N/A

N/A


DX Senior Life

$200

$110

$100

N/A

N/A

N/A

N/A


Plan 1 - Lifetime Membership in 10-10 International Net, Inc. Enclosed is check, money order or charge information in the amount indicated above under Plan 1.


Plan 2 - Lifetime Membership in 10-10 International Net, Inc. on a two payment plan. Enclose the amount indicated above under Plan 2, Payment 1 in the form of a check, money order or charge information. The balance to be paid within one year of this application date.


Plan 3 – NOT available for Senior Life membership. Lifetime Membership in 10-10 International Net, Inc. on a four payment plan. Enclose the amount indicated above under Plan 3, Payment 1 in the form of a check, money order or charge information. The second payment is due within six (6) month of this application date. The third payment is due within one year of this application date. The fourth payment is due within 18 month of this application date.


Plan 2 and Plan 3 include a record keeping fee of Ten Dollars ($10.00). The applicant understands that lifetime membership will not be granted until membership is paid in full.

Email Address for a payment reminder ______________________________

Method of payment(circle one): Check/Money Order Visa MasterCard

_____________________________________________________ DATE : ____________________

APPLICANTS SIGNATURE:

Account number (please include all numbers on your credit card)

Credit card information will appear on your statement as RSVP San Mateo, CA.

____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____ - ____ ____ ____ ____

Expiration Date: ____ ____ - ____ ____ PHONE NUMBER ___________________________________

_____________________________________________________________

CARDHOLDERS NAME IF DIFFERENT FROM APPLICANT (Please Print):

_________________________________________________ DATE : ____________________

CARDHOLDERS SIGNATURE

Please mail completed application to:

10-10 International Net, Inc. 1349 Vernon Ter , San Mateo, CA 94402-3331

Revised 11/15/2011