A membership application form for the SUPERRICHCLUB shopping mall includes sections for the applicant's contact information, membership level selection and pricing ranging from $86 to $10,000, and a statement acknowledging that no refunds will be provided for the membership or digital products and services. The applicant signs to subscribe to the membership and agree to the no-refund policy.

1. MEMBERSHIP APPLICATION FORM
I subscribe to your SUPERRICHCLUB membership and its shopping mall services, and I have
been fully informed and understood the policy that refunds for this membership and its
digital products and services will not be provided at any circumstances.
Name : (Sign)
PRODUCT
POSITION USD POSITION USD
MEMBER $86 EMERALD $1000
BRONZE $100 RUBY $2000
SILVER $200 SAPPHIRE $3000
PLATILUM $300 DIAMOND $5000
GOLD $500 WHITEDIAMOND $10000
INFO
NAME PHONE NUMBER - -
E-MAIL @
USER NAME PASS WORD
ADDRESS
SPONSOR NAME
USER
NAME
2016 年 月 日
NAME : (sign)
www.superrichclub.biz
SUPERRICHCLUB