PassPerfect Associates Discount order form for Bright Trading.

176 Bedford Road

Greenwich, Ct.      06831

Tel: 800-349-3396

Fax: 203-661-7188

Date: __________________

To:

NAME:__________________________________________

SPONSORING FIRM:  BRIGHT TRADING

BILLING ADDRESS (For Credit Card) REQUIRED TO PROCESS CARD:

EMAIL Address (for shipping confirmation or Web-7 sign up):____________________________________________________________

PHONE:________________________________________________________________

FAX:___________________________________________________________________

I hereby authorize PassPerfect Associates to charge my credit card

________________________________________________________________________

My card is__________ the # is_______________________________________________ Exp. Date _____ ______

V CODE ___________(3 digit code on back of card)

Signature_____________________ Print Name_________________________________

Charges will appear on your credit card statement as “Pass Perfect”

Thank you for your order. We appreciate your business!