Silent Star Sponsor Form
BE A PART OF THE VISION
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
example@example.com
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Other (Please specify...)
Will you be willing to recommend us?
Yes
Maybe
No
Please give reference of any three people whom you feel will like to be a Silent Star Sponsor:
Full Name
Address
Contact Number
1
2
Signature
My Products
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LEVEL 1 SPONSOR
Monthly Donation
$
10.00
LEVEL 2 SPONSOR
Monthly Donation
$
25.00
LEVEL 3 SPONSOR
Monthly Donation
$
50.00
LEVEL 4 SPONSOR
Monthly Donation
$
100.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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