SPONSOR  Account Information 

Business Name:____________________________________________			
 
Contact Person:___________________________________________

Person's Position:________________________________________
 
(if not a corporation, owner's name)

Owner's First Name: ______________________________________

Owner's Last Name: _______________________________________
  
E-Mail (if any):__________________________________________  

Address:__________________________________________________  

City:_____________________________________________________ 
 
State / Zip:______________________________________________  

Country (if not U.S.):____________________________________   

Phone (Day):_________________ Fax Number:_________________  

Special Instructions:_____________________________________

__________________________________________________________

Service Package I                ________________

with __ locations                ________________ 

Service Package II               ________________
 
Service Package III (send logo)  ________________

Total Amount                     ________________         

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Please fill-out form and mail to: 

www.epilipinas.com
P.O. Box 867
Artesia, CA 90701
                  Attention:Accounts Dept.

Include check or Money Order for above Total Amount
in (U.S.Dollars) payable to: www.epilipinas.com

Thanks for sponsoring.