Trial Subscription Request

For trial 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

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:_______________@_________________________

Trial Subscription Conditions: (Very Important!!- Read carefully before signing)

    You must fill out this form completely, including the payment portions, and submit it to Netlaw Libraries. After submission, your UserID and Password will be entered to activate your trial period account. After the 2 week trial period you will automatically be billed for the next month's service UNLESS you inform Netlaw Libraries that you wish to cancel the service prior to the expiration date. Notice may be by letter, fax, e-mail, or telephone but it is the users responsibility to cancel the service.

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

Invoice:
Month to month *(Requires initial two month subscription)
Quarterly
Annual

Credit Card: (automatically charged 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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