Name *

First Name

Last Name

Phone *

(###)

###

####

Did someone refer you? If so, who?

First Name

Last Name

I AM FULLY PREPARED TO INVEST IN MYSELF AND IN MY BUSINESS. *

YES

NO

I UNDERSTAND THE TRAINING & MATERIALS I WILL RECEIVE IN BASIX ARE FOR INFORMATIONAL PURPOSES ONLY AND NOT FOR THE PURPOSE OF PROVIDING LEGAL OR TAX ADVICE. *

YES

NO

I UNDERSTAND THAT ALL SALES ARE FINAL, WHICH MEANS NO REFUNDS AND I AM GUARANTEED ABSOLUTELY NOTHING BY JOE HAMGERI, LLC. *

YES

NO

I UNDERSTAND THAT IN ORDER TO GET RESULTS, I MUST WORK HARD AND SMART AND TAKE ACTION. I KNOW THAT I WILL FAIL BEFORE I SUCCEED BECAUSE THAT'S WHAT SUCCESS TAKES. *

YES

NO