Your Name______________________________________________

Phone_________________________ Email ______________________ Country___________
Method of payment (Circle One)  Money Order * Cashiers Check * Credit Card * Western Union

(If ordering via a credit card, the name on the card MUST be the same as the enrollee)

CC#___________________________________ EXP______ name on card _____________________

Billing address____________________________    CC signature________________________

Please accept my order for Classic training package (& any optional discs checked below) :
Simple Index Trading Training (live & recorded) & Trial monthly membership- just $1897  $1497
(then just $19.95/monthly after 30 days unless you cancel)- Hurry Before Price Goes Up!
Options:
__ Please Add Mindset Disc (USA & Canada Only) For $67 (total = $1564) ___ Canada add $25 shipping (total =$1589)
__ Please Add Tax-Free Disc (US Only) for $67 (total = $1564)       ___ Add Both discs for $97  (US only - total $1594)

Your Address____________________________________City__________________________

State or Province ____________  Postal Code____________  Country___________________
AGREEMENT & DISCLOSURE

The risk of loss with any type of trading including futures and the E-mini contracts can be substantial. You should consider carefully whether such trading is right for you. You could sustain a total loss of the funds you deposit with any broker, and you may incur losses beyond these amounts. By ordering the Classic and/or Premiere Day Trader training from Kosoma LLC you agree that the trades and system taught are based on the Kosoma "Big Money in little trades" program and are for educational purposes only. You agree to accept full responsibility for your actions and will hold Kosoma LLC, or any of their representatives harmless of any losses you may incur. You also agree that the day trading techniques you will learn are considered proprietary information and that you are not to share this information with anyone except a spouse. Enrollee is at least 18 years of age, is mentally competent, is not a Debtor-in-Bankruptcy, and is under no legal incapacity to enter into contractual agreements. You further agree that you will not attempt to sell this or similar information (other than referring ones to Kosoma LLC).

You agree that this is a non-disputable, and non-cancelable enrollment
 

Your Signature _______________________

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Send your order to:
 Kosoma Publishing * P.O. Box 89 * Moyers, OK 74557
   FedEx & Overnight Address is: Hwy 2 North * Moyers, Oklahoma 74557
Or Fax this form (credit card & Western Union orders only) to:  (603) 386-6850
             Note - Keep a copy of this form for your Records!