Amber Telcom, 17 Ensign House, Admirals Way, Docklands
            London   E14 9XQ   England
      Telephone ++44  (0)844 4961 509
   Fax ++44 (0)844 4961 519
 

CLICK HERE TO PAY BY CREDIT CARD

 
 





APPLICATION FORM
 

Full Name 


Address
 
 


Telephone Number
Fax Number
e.mail

Option 1                                                                                                £100 deposit
Option 2                                                                                                £500 deposit
Option 3 Standard                                                                               £750 deposit
Option 3 Complete(includes guaranteed earnings)                        £1250 deposit
or other specific package

Have you chosen a name or will you leave it to us


What name would you require
you earnings sent in
(social security number required for US residents)

Total Enclosed Payment Cheques Payable to Amber Pro Inc.

Any extra request
 


 

    Your Signature(s)                                                      Date
 
 


PLEASE PRINT THIS APPLICATION
AND SEND IT TO US WITH YOUR PAYMENT
 

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