START SELLING AVON

*If yes --Please tell us the name of the bank and the City it's in:


*Do you have a drivers license?                   

*If you do, what is the driver's license number?                    (If no --just put 000)

*Your Social Security Number:                   

*Employed By?

*Did you ever sell Avon Before? If yes, where?

Please enter one:
W=White, A=Asian, H=Hispanic, AA=African-American or O=Other



Amount Due: one (1) Avon kit.


Payment Options:

You may pay for your kit via 3 different convenient ways. I have your kit right here in my office ready to ship to you! Please choose:

PayPal.com
Mail in Money Order (Please make out to Kelly Land)
Credit Card (Your statement will show a $10 charge from MMMommy)

Note: Be sure to submit THIS form at the bottom of the page.

Payment By Credit Card:
(We prosecute Credit Card Fraud to the Maximum Ability of the Law. In some cases we will call the cardholder to confirm charges before processing. Your IP is being noted as well. We do not tolerate any form of payment fraud. All card processing is done on a secure 128 bit encrypted server.)

*Please fill out all fields

Visa
Mastercard
Discover
American Express

Name on Credit Card:

Card Number:

Expiration Date:

3-digit CVV# on back of card:

AMEX 4-digit CVV# on front of card:

Please initial here. I authorize you to charge my credit card for the above selected items in the amount shown.