FAX THIS FORM TO: (319) 277-0062 OR MAIL TO: Jim Wyckoff 3221 Cobblestone Court Cedar Falls, IA 50613-7136 Dear Jim, Sign me up! I'd like to have you on my trading team. I'd like to ___ Pay (by credit card) by the month at $34.95/mo. ___ Pay (by credit card) by the quarter at $89.95/quarter ___ Pay by the year at $299/yr. Method of payment: ___ My check is enclosed ___ Charge to my MasterCard ___ Charge to my VISA (Please do not send cash through the mail) Billing address card statements are sent to: _______________________________________________________ _______________________________________________________ Mailing address: _______________________________________________________ _______________________________________________________ E-mail address: _______________________________________ Credit card number: ________-________-________-________ Expires: ____/____ Signature of cardholder: ______________________________