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First Name		Last Name

Company Name

Address


City		State	Zip

Alternate State NON-US		Country



Phone	Cell	Fax

eMail Address



User/Nick Name		SSN / Tax ID Number

System Password

Re-enter Password

^{By submitting this form you are agreeing to the Terms and Conditions!}

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SSN / Tax ID Number

If all goes well we will be sending you a check each month. For us to be able to pay you we have to report to the IRS who we paid and how much. You can be sure that no one but us and the IRS will ever see your information, and the IRS already has it anyway. ;)

Password

This is how you will connect to your 'Back Office' to manage your settings and view progress. It should contain alpha and numeric characters (letters and numbers) so it is harder to guess. Also try not to forget your password, it can be reset however if you do. Be sure to verify your password, it must be exact.

User / Nick Name

This is the name associated with your icon in the graphical areas of the 'Back Office'. You may also choose to use this as your login credentials. This must be unique from any other Member's on the system. Keep it fairly short so it will fit nicely on all the areas of the 'Back Office'. Also this will be the directory name for your custom website.
Example: if you use John316 as your user name then your website link will be...
'http://www.thegoodplanner.com/john316'

Email Address

We do not send many emails out, you will find your 'Back Office' internal messaging works better. Due to the large amout of SPAM in email, sometimes important messages may not be recieved. You may opt to forward your internal messages to this email address later on. This email address may also be used as your login credentials.

Terms and Conditions.

					<p> </p><p>Thank you for purchasing <strong>EZ Cardio</strong>!</p><p>Each container of <strong>EZ Cardio</strong> is a 30 day supply. Please remember to re-order <strong>EZ Cardio</strong> and allow up to 7 days for delivery.</p><p><strong>Disclaimer:</strong> The GOOD Company has provided information from studies concerning the ingredients of <strong>EZ Cardio</strong>. We do not guarantee results.</p><p>The GOOD Company will stand behind the quality of our products and if there were ever a quality issue we ask you to send an email to <a href="mailto:dougbaswell@charter.net">dougbaswell@gmail.com</a> for instructions.</p>

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