Name: __________________________________________________________________ Date: _____________________

Address: _______________________________________________________________________ Apt.________________

City: __________________________________________________ State: ___________ Zip: _______________________

Phone: ______________________________________________________

Email: ____________________________________________________________________________

______ YES, I'd like to order the "Paint Party Profits" program for $497. I'm enclosing a check or money order for $497.00 payable to: Paint Party Profits

*** Send this form or use a separate piece of paper and include all of the information above.

Send To:

Paint Party Profits
P.O. Box 943
Long Beach, MS 39560