<form action="http://earnwithtycoon.com/flipsquad/processnewmember.php?" method="post"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div align=center> <h2>New Member Signup</h2><br /></div><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div align=left><!-- [et_pb_line_break_holder] --> <h3>Member Information</h3><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="first_name">First Name</label><!-- [et_pb_line_break_holder] --> <input id="first_name" name="first_name" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="last_name">Last Name</label><!-- [et_pb_line_break_holder] --> <input id="last_name" name="last_name" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="businessname">Business Name</label><!-- [et_pb_line_break_holder] --> <input id="businessname" name="businessname" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="password">Requested Password</label><!-- [et_pb_line_break_holder] --> <input id="password" name="password" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="password">Repeat Password</label><!-- [et_pb_line_break_holder] --> <input id="password" name="repeatpassword" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /> <br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="email">Email</label><!-- [et_pb_line_break_holder] --> <input id="email" name="emailnew" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="phone">Phone: </label><!-- [et_pb_line_break_holder] --> <input id="email" name="phonenew" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="website">Website</label><!-- [et_pb_line_break_holder] --> <input id="email" name="websitenew" type="text" class="form-control" style="height:30px;" /><!-- [et_pb_line_break_holder] --> <br /> <br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> Level <select name=tedlevel><option value=0>Select</option><!-- [et_pb_line_break_holder] --><option value=1>Silver</option><!-- [et_pb_line_break_holder] --><option value=2>Gold</option><!-- [et_pb_line_break_holder] --><option value=3>Platinum</option><!-- [et_pb_line_break_holder] --></select><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <br /><!-- [et_pb_line_break_holder] --><br /><!-- [et_pb_line_break_holder] --> <h3>Billing Information</h3><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <font color=black>We accept Visa, Mastercard, American Express and Discover. Monthly Services will be billed every 30 days unless service is cancelled. By submitting payment you agree to the terms and conditions of Earn with Tycoon/2 Life Architects</font><!-- [et_pb_line_break_holder] --> <br /><!-- [et_pb_line_break_holder] --> <br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="couponcode">Card Number</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control" style="height:30px;" name="cardnumber" id="cardnumber" /><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="couponcode">Exp Date (00/00)</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control" style="height:30px;" name="expdate" /><br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="couponcode">CCV Number </label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control" style="height:30px;" name="securitycode" />(Last 3 digits on back of card or 4 digits on front of AMEX)<br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <br /><!-- [et_pb_line_break_holder] --> <h3>Billing Address Information</h3><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="couponcode">Address</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control" style="height:30px;" name="street" /><br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="couponcode">City</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control" style="height:30px;" name="city" /><br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="couponcode">State</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control" style="height:30px;" name="state" /><br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <label for="couponcode">Zip Code</label><!-- [et_pb_line_break_holder] --> <input type="text" class="form-control" style="height:30px;" name="zip" /><br /><br><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> Terms of Agreement go here<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <p class="submit"><!-- [et_pb_line_break_holder] --> <button type="submit">Sign Up</button><!-- [et_pb_line_break_holder] --> </p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> </form>