“WLLC – Mail-In Application”

“The World’s Largest Lotto Club”

Mail-In Application

Important! You must know your Sponsor’s Name (Invited By) and Sponsor’s ID Number

If you do not know your Sponsor’s Name and/or ID Number, get back to the person who invited you or call the Quarterly Connection office at 719-655-2630 to help you.

Sponsor Name (Invited By)

Sponsor ID #

Your Information:

First Name

Last Name

Your Name how you want it to appear on your Flyer

Mailing Street Address or PO Box

City or Town

State

Zip Code

Your Phone Number (For office use only)

Do you want your Phone Number on your Flyer for better response?

Yes No

Your email address (For office use only)

By my Signature, I agree all sales are final and that there are Absolutely No Refunds. You agree that by “Typing your Name” it becomes your legal Signature.

Signature (Type your Name)

Date

Note: After downloading, open the file in your browser and print it. Mail the printed form with $159 (Cash, Check, or Money Order) to Quarterly Connection, PO Box 468, Moffat, CO 81143.

Note: All information must be provided in order to “Download and Print

WLLC Mail-In Application

Fill in all fields below, then click Download & Print. Mail the printed form along with your payment to: Quarterly Connection – PO Box 468 – Moffat, CO 81143-0468

Note: All information must be provided in order to Download and Print.

Sponsor Information

Your Information

First Name*

This field is required

Last Name*

This field is required

This is your legal name for your commission checks.

Your Name — how you want it to appear on your Flyer*

This is how your name will print on the flyer.

This field is required

Mailing Street Address or PO Box*

This field is required

City or Town*

This field is required

State*

Required

Zip Code*

Required

Your Phone Number* (For office use only)

This field is required

Do you want your Phone Number on your Flyer?*

Yes No

Please select an option

Your Email Address (For office use only – optional)

Agreement & Signature

By my Signature, I agree all sales are final and that there are Absolutely No Refunds. You agree that by “Typing your Name” it becomes your legal Signature.

Signature (Type your Name)*

Your signature (typed name) is required

Date* (Click on Calendar)

This field is required

Note: After downloading, open the file in your browser and print it. Mail the printed form with $159 (Cash, Check, or Money Order) to: Quarterly Connection – PO Box 468 – Moffat, CO 81143-0468.

If you would like to Mail-In your payment with your Credit/Debit Card instead of transmitting it electronically, please check this box.