Name ____________________________________________________________

Title For Agents Web Page ________________________________________

We use your Phone Number for tracking and agent ID.

Phone Number ______________________ Fax __________________________

Address ___________________________________________________________

City _____________________ State ___________ Zip Code _______________

Country ___________________________________________________________

Email: ____________________________________________________________

Sponsor: _Tim Sprowl _Phone: _ 812-829-0964_ Email:_Cat2917@aol.com

( _ ) I want to secure my permanent position immediately! Enclosed is $85.00 to cover my first years "Matrix Fee" ($25.00), and payment of ($60.00) to reserve 12 "Basic" Web Sites,

( _ ) I do not want my permanent placement yet and understand that I will not be placed in a permanent position in the Barn Sides Agent Matrix until I have bought or sold 3 Web Sites and paid the $25.00 "Matrix Fee".

I/We, the undersigned, agree to the rules, set out by Barn Sides, and understand these rules are subject to change. (with 30 days notice)

Signature _______________________________ Date ______________