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WELCOME TO TWISTED QUEEN FINANCIAL & TRAVEL LLC
New Member Enrollment
First Name
*
First Name Spouse
Last Name
*
Last Name Spouse
DOB
*
DOB
Last 4 of Social
*
Last 4 of Social Spouse
City
*
Address
*
State/Province
*
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code
*
Phone
*
Phone Spouse
Email Address
*
Email Address Spouse
What Twisted Package Are You?
*
Twisted Effect Single ($206.00) Monthly $105.00
Twisted Couples Affair ($382.00) Monthly $200.00
Twisted Experience Single ($806.00) Monthly $403.00
Twisted Couples Experience Express ($1400.00)Monthly $750.00
Twisted Travel Regular Membership plus $75 Initial one time Fee ($140) Monthly $65
Twisted Travel V.I.P. Membership plus $75 Initial one time Fee ($175) Monthly $100
Twisted Membership
*
Twisted Effect Single
Twisted Couples Affair
Twisted Experience Single
Twisted Couples Experience Express
Twisted Travel Regular Membership
Twisted Travel VIP Membership
Preferred way to contact
*
Phone
Email
Any
Preferred way to contact Spouse
Phone
Email
Any
Name on Card
*
Credit Card Type
*
Visa
MasterCard
American Express
Discover
Credit Card Number
*
Expiration Date (mm/yy)
*
CVC
*
Who Referred You?
*
Terms and Conditions
*
You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.
Please sign
*
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Please sign
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