Higher Response Marketing, Inc.



Amazing Formula Big Course - Boot Camp
Only $500.00




Personal Information
Name(First/Last)
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Credit Card Information

   
Name on card:
Credit card number:
Expiry Month:
Expiry Year:

Check Information
   
Type of Check:
Check Number:
Check MICR Number:
Example MICR Number: Click Here
Drivers Licence Number:
State of Drivers Licence:

Billing Address
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No tolerance policy with charge back requests
We reserve the right to file civil charges against bogus charge back requests using the digital identity law in the state of Texas.  This new law accepts IP addresses as legally binding proof of your identity and your order.  We log your IP address with software that sees through anonymous IP address services and software.  By ordering, you agree to pay any and all civil damages (which are considerable) if you dispute the charge with your credit card company.  Disputes concerning charge backs will be resolved by a board of arbitration of our choosing in Dallas, Texas.
Return Check Fee by State: Alaska, $25; Alabama, $28**; Arkansas, $25; Arizona, $25; California, $25; Colorado, $20**; Connecticut, $20; District of Columbia, $25; Delaware, $30; Florida, $25**; Georgia, $25*; Guam, $20; Hawaii, $20; Iowa, $20*; Idaho, $20; Illinois, $25**; Indiana, $20*; Kansas, $30; Kentucky, $25*; Louisiana, $25*; Massachusetts, $25; Maryland, $35; Maine, $25; Michigan, $25; Minnesota, $30**; Missouri, $20; Mississippi, $30; Montana, $30; North Carolina, $25; North Dakota, $25; Nebraska, $35; New Hampshire, $25; New Jersey, $30; New Mexico, $30; Nevada, $25; New York, $20; Ohio, $30*; Oklahoma, $25*; Oregon, $25; Pennsylvania, $30; Puerto Rico, $10; Rhode Island, $25; South Carolina, $25; South Dakota, $30; Tennessee, $20; Texas, $25**; Utah, $20; Virginia, $25; Virgin Islands, $20; Vermont, $25; Washington, $25**; Wisconsin, $25**; West Virginia, $15; Wyoming, $30*.

* Fee shown or the maximum amount permitted by law.
** Check writer also responsible for all other costs of collection.
Transaction Authorization: By typing in my driver’s license or identification number above and submitting this order form, I confirm that I am the owner of the account identified by the MICR numbers entered in the Internet check above and authorize this merchant and/or TeleCheck to convert my account information entered above into a paper draft drawn on, or an electronic debit to, my account for the amount of this transaction. In the event that my paper draft or electronic debit is returned unpaid, I agree that a returned item fee also may be debited from my account electronically or drafted via paper draft. The amount of the fee will be determined by the state where my billing address is located. (See the list below for the fee for your billing address.) Further, by submitting a transaction, I expressly authorize this merchant to obtain a report of my check-writing history from TeleCheck to prevent fraud and for other authentication purposes. For more information on TeleCheck’s process and privacy policy, see Internet Check FAQ and TeleCheck Privacy Policy.


PROBLEMS?

FOR ASSISTANCE CALL

1-250-748-5580


Or, contact us at support@amazingformula.com.