Your Name: *
Your Email (to receive gift certificate): *
Your Refer Code:   

Are you a Z57 client? Yes  No
If so, what is your domain name?

Here is your opportunity to earn unlimited $25 Amazon.com® gift * certificates! Simply fill out the following form and for each colleague that you refer that purchases Agent Excellence, you will receive a $25 Amazon.com® gift certificate...it's that simple!

Referral 1
Name: * Phone: *
Email: * Fax:
Referral 2
Name: * Phone: *
Email: * Fax:
Referral 3
Name: * Phone: *
Email: * Fax:
Referral 4
Name: * Phone: *
Email: * Fax:
Referral 5
Name: * Phone: *
Email: * Fax:

The information supplied is only for referral purposes, and is not used in any other way.


Z57 Internet Solutions
www.z57.com

Effective 5/10/04 the gift certificate amount awarded is $25.
This supersedes all previously advertised offers.
Disclaimer

* Amazon.com is not a sponsor of this promotion. Amazon.com, the Amazon.com logo, and 1-Click are registered trademarks of Amazon.com, Inc. or its affiliates. Amazon.com gift certificates are redeemable only at www.amazon.com.
* See www.amazon.com/gc-legal for terms and conditions of use of Amazon.com gift certificates.