ARTISTIC!'S CAPITAL CORPORATION'S REFERRALS FORM

ARTISTIC!'S REFERRALS FORM

"MAKE EASY MONEY ... JUST TALKING TO OTHERS!"
$100.00 On Enhancement Referrals ► $50.00 On All Other Referrals

Just complete this form and return to us by email, fax, or directmail it to us for immediate action. We will notify each person listed below
with our corporate literature by email or directmail, and pay you immediately when they register or signup for any of our unique services
or programs. You shall not be considered an employee of our agency and you will remain responsible for your own personal or business
taxes when your commissions are paid. A W-9 Form will be sent to you for signature before any commissions are paid to you directly.
Thank you for completing our Referrals Form and we look forward to working with you.

YOUR NAME: (PRINT LEGIBLY)
YOUR ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)
WEBSITE URL: (IF ANY)
HOW DID YOU HEAR ABOUT US?
WHAT IS YOUR DATE OF BIRTH?

NOW PROVIDE YOUR REFERRAL INFORMATION BELOW AND RETURN!!

REFERRAL NAME #1:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #2:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #3:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #4:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #5:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #6:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #7:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #8:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #9:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #10:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #11:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #12:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #13:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #14:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #15:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #16:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #17:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #18:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #19:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #20:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #21:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #22:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #23:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #24:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

REFERRAL NAME #25:
REFERRAL ADDRESS:
CITY, STATE, ZIP CODE:
EMAIL ADDRESS:
TELEPHONE #: (W/AREA CODE)

Return this form by email to:
referrals@artistic-capitalcorp.com

Fax the form to: 1-866-RTISTIC!
(1-866-784-7842) 24/7

Directmail form to:
Artistic! Capital Corporation
Attn: Referrals By Mail Program
342 E. Jericho Tpke., Ste. 334
Mineola, NY 11501-2111