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Google Money Words Program Signup Form

Firm Name

First Name *
Last Name *

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Representative

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I understand that I will be billed for the amount stated in the box below for 12 months. If I terminate or cancel the service within the 12 months, I understand that I will be billed $499.00 for the Software Licensing Fee. Termination must be by certified mail.

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I accept terms and conditions

Date *

By clicking the accept button, you are authorizing payment to your credit card and understand and accept terms and conditions above, in order to proceed.