Janice Petteway's
Custom Coaching by Design

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Subscription Order Form

New! Monthly Group Coaching!

Name:

Billing Address:
Must match address of credit card  on file

Billing City State Zip:

Shipping Address:
If different from billing address

Shipping City State Zip:

Company:

Home Phone:

Office Phone:

Cell Phone:

Fax:

Email:

Products:
Coaching prices include Set Up Fee, but not applicable S/H or Sales Tax

Price List 

Custom Coaching $999 Monthly
Premium Coaching $499 Monthly
Monthly Group Coaching $500 Monthly

Payment Method:

Credit Card Holder Name:
complete this section if you wish to use your credit card for payment

Account Number:

Exp. Date: mm/yy

CCV:

Bank Name:
complete this section if you wish to pay by direct debit

Account Number:

Bank Routing Number:
If you are unsure of your account's routing number, please contact your bank for that information.

Bank City State:

Please Click Here to print out the form you must sign and return to us authorizing your debit.

I have read and accept the terms and conditions of the Agreement as set forth below.

1. TERM The term of this Agreement for all coaching subscriptions and product subscriptions shall be one year. The client may pre-pay the initial one year term of any subscription or elect to be billed monthly. After the expiration of the initial one year term, the Agreement will continue from month to month until cancelled by client. 2. Charges The total cost for coaching or product subscriptions includes a one time fee (specified herein as the “set up fee”) to cover the cost of set-up and initial materials. If the client elects to prepay, the total cost will include the set up fee. If the client elects to pay in installments, the client will be charged the set up fee, followed by twelve monthly installments. 3. License This Agreement constitutes a personal, non-assignable license for the undersigned to use the products, services or information provided in conformity with the systems or methods presented for his/her personal or existing business purposes not related to training or coaching. Any other duplication, dissemination, use or resale of said products or information is prohibited. 4. Payment: I authorize Janice Petteway or her authorized agent, in accordance with this Agreement, to initiate debit/credit entries to my checking, savings or credit card account as provided herein. 5. Termination This Agreement may be terminated at any time by Janice Petteway for Cause, which shall include, but not be limited to, the Breach of this Agreement by the client, abusive or unprofessional conduct, or conduct which would tend to hold Janice Petteway up to embarrassment or contempt.

Questions? 1-800-788-2150 ext 101 
Janice Petteway
Founder
customcoachingbydesign.com

Owner
Exit Real Estate Results
Longwood - Orlando - Winter Springs

Top Producing Agent for 18 years.

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