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Secure Distributor Sign-up Form

Print this form. Complete appropriate entries and mail with check or money order.

Distributor Sign-up Form
For faster service, order by phone 702-453-0975 and charge to your Visa/MasterCard or order by fax 24 hours a day 702-453-0975.
E-Mail: [email protected]
KKZ Company, LLC, 6055 E Lake Mead Blvd #202, Las Vegas, NV 89156
YES! I want to begin earning money in my own mail order book business. Enroll me today under the plan checked below.
( ) Enroll me as a SUPER & MAILING LIST DISTRIBUTOR eligible for the Super & Mailing List discounts & benefits. Enclosed is my $110 one-time fee, plus $4.00 shipping - Total $114.00.

( ) Enroll me as a SPECIAL DISTRIBUTOR eligible for the Special Distributor discounts & benefits. Enclosed is my $55.00 fee one-time, plus $4.00 shipping - Total $59.00.

Canada shipping, add $5.00 -- Overseas Airmail, add $13.00

Payment by: ( ) Check ( ) Money Order ( ) Visa ( ) MasterCard
Name ___________________________________________________________________
Address: _______________________________________________________________
City ________________________ State/Province _________ Zip/Postal _____________
Credit Card Number ___________________________________ Expiration __________
Signature _________________________________________________
Phone Number (for office use only) ___________________________

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