Please complete and fax or mail to Home-Based Working Moms

HBWM Membership $69 (One Year)
HBWM Membership $129 (Save $9 - Two Years)
Work-at-Home Kit $119+$8.50 s/h ($127.50) (includes membership and other items)

Free T-shirt. Select Size
Med   Large   X-Large   (They run small so order a size larger than you usually wear.)

Name: Address:
(Street Address (not PO Box) required for Credit Card Processing and Verification)
City : State/Province: Zip: Country:
Phone: Fax:
E-mail:
Web site address (if any):
Business Name (if any):
Type of business:
Number of children: Child(s) date(s) of birth (Mo/Yr):
Are you: Married Single Divorced Widowed
What articles/information are you most interested in:
How did you learn about HBWM? (Please specify specific search engine, magazine, web link, friend, etc. if known)
TOTAL DUE (Texas sales tax* if applicable): $

*Texas residents add 8.25% for work-at-home kit, not membership. (Canadian membership orders add $4 U.S. ($10 for Kit); Other countries add $10 U.S. for membership or $20 for kit.)

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Account # Expiration Date:

Signature: ___________________________ Name on card:

Your membership and/or work-at-home kit will be sent to you in approximately 2-3 weeks. There is a 30 day money back guarantee. If you aren't satisfied with your membership and materials, you may return them for a full refund less a $4 handling fee for membership and $10 for Biz Kit.

Fax to 281.350.4390
Mail: HBWM Membership, PO Box 1628, Spring TX 77383-1628
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