Online Enrollment

Your Sponsor: LEONARD C. GALLOWAY, JR.

Please fill in all fields on the application below.

Applicant Information
First Name
Middle Initial
Last Name
Suffix (II, III, Jr, SR, etc.)
Add A Business Name (if applicable)
Business Name
(if applicable)
If a Business Name is entered here, your myEcon commissions will be issued to and deposited into the bank account of the Business Name entered. Be sure to have a bank account in the Business Name entered.
Business Owner
(only if different from above)

Note: Commissions will be paid to this business name. Please ensure you have a Bank Account in this Business Name.
Add Spouse/Business Partner Information (if applicable)
Spouse/Business Partner Information (optional)
Spouse/Business Partner First Name
Spouse/Business Partner Middle Initial
Spouse/Business Partner Last Name
Spouse/Business Partner Suffix (II, III, Jr, SR, etc.)
The Spouse/Business Partner name is for INFORMATION PURPOSES ONLY. Commissions will be paid in the name of the Primary Associate or Business Name only.
Shipping Address (No PO Boxes)
Address
City
State
Zip
County
Enter the County for your State
Phone and Email
Mobile # ( ) -
Home/Office # ( ) -
Email Address
Email Address (re-enter)
Enrollment
I elect to enroll in the selected membership below and agree to pay associated one-time fee and ongoing monthly fee:
(initial here)
 $0.95* Black Friday Weekend Special ($9.00 Off the already discounted price of $9.95) :: $0.95* one-time and then $39.95* monthly beginning 30 days after enrollment:  The Financial Success Membership (FSM) includes our (1) W4 Tax Training Strategy, (2) myCredit System, (3) Cashflow Manager App & Tax Record Keeping System, (4) Debt Elimination Software, (5) Investment Education Training and have the opportunity to earn affiliate commissions.
* plus applicable sales taxes
Upgrade My Membership
(initial here)
 $11.00 - UPGRADE my membership with the Zingo Travel Club for $11.00 now and then an additional $11.00 monthly plus the $39.95 FSM monthly membership fee for a total ongoing monthly fee of $50.95.
* plus applicable sales taxes
Coupon Code (optional)
Coupon Code:
The coupon code value must be less than or equal to the membership enrollment cost.
Coupons can only be used for enrollments.
Personal Financial Success Training Manual (optional)
(initial here)
 Only $24.95 at time of enrollment  Complete Personal Financial Success Training Manual with professional three ring binder, embossed with the myEcon logo and full training inserts and tabs. Regular price $38.00.
* plus applicable sales taxes
User Name / Web Address
Choose your username, which becomes your email and web address at myEcon.net
(Example: username=Joe web address will be http://joe.myEcon.net
.myEcon.net
Note: Do not enter your email address here
Password
Choose your password
Confirm your password
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