DHS Club Upgrade Application

This printable application is to be used when submitting payment by credit card only. Please complete, print and sign the application and fax or mail to the address listed below. If you wish to electronically upgrade your Membership go to the: Upgrade Application

Sign Me Up! Yes, sign me up as a DHS Club VIP or Partner as I have chosen below. I have read and agree to the DHS Club's Terms.

Customer Information:

First Name:
Middle Name or Initial:
Last Name:
Date of Birth:
Address:
City:  
State or Province:
Postal/Zip:
Country:
Email:
Home Phone:  
Fax:
Your Id:
Don't know your ID? Put your sponsor's
ID here:

Name on Card:
Type of Credit Card:
Card Number:
Expiration Date::

*** Important *** Please select the statement that applies to you, if you understand and agree.

For VIP Applicants Only.   I hearby authorize DHSC, Inc. to charge the account named above $49.95 USD for my initial fee and $25.00 USD per month for my monthly fee. I understand that the monthly fee is to be charged on the first of each month, beginning with the first calendar month after my sign up. (Note: This may make your first monthly fee occur as soon as the day after your sign up, should you sign up on the last day of the month).


I also understand that DHSC's rights in each transaction shall be the same as if I had personally authorized each charge. This authority is to remain in effect until DHSC receives written notification from me of its termination, such notice NOT to occur less than 15 days prior to the due date of any given payment.

For Partner Applicants Only. I hearby authorize DHSC, Inc. to charge the account named above $34.95 USD for my Partner's subscription fee.


CANCELLATION - I understand that I can cancel my Partner or VIP Membership within 72 hours of submitting my application and receive a full refund. I understand and agree that this agreement may be terminated by myself by giving notice in writing by fax or e-mail.

Print this form and sign here   Date: ___/____/_____

*** Important *** Print this form , then sign the form, then fax it or mail it to the address below.


I have read the terms of agreement and:
You must check one of the following:  I AGREEI DISAGREE


All fraudulent credit cards are reported to the United States Secret Service.

The DHS Club
2560 Placida Road
Englewood, FL 34224-5412
Fax: 1-941-475-4081

Welcome To The Club !


 
6/22/2000 GSB