Subscription Request

For subscriptions, print this form, then mail this form to the address shown at the bottom of this page or FAX the completed form to (858) 486-9079. Most faxed requests are processed and accounts ready for use within 1 day (or less) from the time of receipt, weekends excepted. We will contact you by E-Mail as soon as your request has been processed

We will contact you by E-Mail as soon as your request is processed
If you are faxing this form you MUST still mail the original form to us with an original signature
First Name: _________________MI: _____

Last Name: _____________________________

Firm: ___________________________________Title/Occupation: ___________________

Address:________________________________Suite:______

City:____________________ State:___Zip:________

Work Phone:(___)___________ Ext:_____ Fax Number:(___)____________

Home Phone:(___)__________

E-Mail Address:______________@__________________________

For which Plan would you like to subscribe?

A.Month-to-month Plan: $50.00/mo., billed and payable monthly;(see Invoice Plan below)
B. One year Plan: $600.00/once a year, billed and payable annually (This Plan gives you 14 months of access for the price of 12 months.)
C. Daily Use Plan: $10.00/day, Access monitored on a daily basis. If the service is accessed during any 24hr period (12:00am to 11:59pm) the account is billed for one day. Invoice accounts not available for daily access (VISA/Mastercard only!!!)

(All billing plans require payment in advance.)

How Would You Like To Pay for your subscription?: (check one)

Invoice:
Month to month *(Requires initial two month subscription on all invoiced accounts)
Quarterly
Annual

Credit Card: (Automatically charged in advance each billing period for subscriptions)

Visa MasterCard Card No:_______-________-________-________Exp. Date:____/____

Name as printed on card:(Print)_________________________________________

My signature below authorizes Netlaw Libraries to automatically bill me or debit my accounts or credit card as indicated above. I understand that all payments are in advance and are non-refundable.
Signature:____________________________Date:____/_____/____

User ID:___________________Password:____________________ (is case sensitive and must be at least 5 characters but no more than 8)

13405 Tobiasson, Poway, CA 92064 (smclaw@netlawlibraries.com) Tel: (858) 486-3329 Fax: (858) 486-9079
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