Mail Application


Name:                                                                       Date:
Phone Number:
Business Name:
City:                                                                          State:
Location: (area or city where you work)
License #
Massage Rates:
Description of Services - Sell yourself, what do you do best? (30 words or less)

                                       Print this form and mail with check for $ 39.95
                                       Make check out to Discount WWWorld Inc.

                                       Send to:  Discount WWWorld Inc.
                                                      Massage Referral Service
                                                      4640 25th Avenue North
                                                      St. Petersburg, Florida  33713