PRINT, COMPLETE, SIGN & FAX TO (888) 521-7849

MS Home Solutions
  
Phone: (601) 544-9400
Fax: (888) 521-7849




CASH REWARD PROGRAM REGISTRATION FORM

Name Home Phone (     )
Mailing Address Work Phone (     )
City                            State            Zip Cell / Pager (     )
Social Security # Email Address

ACKNOWLEDGEMENTS

I hereby acknowledge and agree that:

I am not an employee of MS Home Solutions. Therefore, I am responsible for any income tax liability and for notifying the IRS of my earnings.

Either, MS Home Solutions or I may choose to terminate my participation in the CASH REWARDS PROGRAM at any time and for any reason.

If I earn $600 or more during any calendar year, MS Home Solutions will issue a 1099 IRS Form for tax purposes as required by law. Further, I will cooperate fully with the preparation of this form by supplying my Social Security Number to MS Home Solutions as indicated above.


Signature
Date