Pot of Gold Application Form

Netherlands Pot of Gold Program - APPLICATION -
Name		Address
Post/Zip code		Town/City
County/State		Country
.		Email
Number of places in the Universal matrix. Your first place will be "under" your sponsor; additional places as re-entries in the "universal matrix".	.	Cash payment in bank notes send with this application Fill in the currency and the amount.	.
Payment may be made in any West European currency or in American, Canadian or Australian Dollars (for any other currency: please ask via Email info@jisl.com). The payment in a foreign currency must approximate the value of the amount in American dollars for the number of places at $ 5 (five American dollars). For example: a German applicant can send a DM 10 bank note per place. A Dutchman a bank note of 10,- etc. If the value of this payment is marginally more or less than the exact amount that has to be paid, JISL will settle the difference with the proceeds from the matrix.
Date, _________________________19 You do NOT have to sign this application; you do not commit yourself to any obligation what so ever!		The sponsor of this this applicant is: Cassandra Johnson ID #AMBS203MB06 Write here the number and the name of the sponsor, or if this is not known yet, the full name and address etc
Please send this application to: "FDG" - Postbox 6403 - 5600 HK Eindhoven - The Netherlands Internet: www.jisl.com - Email address: gimmick@jisl.com North American Residents: US - send application along with a $7.75 US Postal Money Order (payable to HAP) and a long self-addressed stamped envelope to: HAP, 12472 Lake Underhill Rd., Suite 306, Orlando, Florida 32828 USA Canada - send $8.25 (US) Money Order and a long self-addressed envelope to HAP at the address above. (return postage to you included in $8.25) HAP ENSURES THAT YOUR APPLICATION WILL BE SENT TO THE NETHERLANDS VIA FED-X OR UPS 2 DAY EXPRESS DELIVERY THE NEXT DAY UPON RECEIPT.