Print this form and use it to join Bethany's Woodshed via FAX

Name: __________________________

Address:_______________________________

Address: ______________________________

E-mail (Required): __________________________

Card number: ________________________

Expiration Date: ________ CVV2: _______

Card type (Visa and Mastercard): _____________

You may join any of our credit card options by faxing in your credit card. Please circle the option you would like:

REBILLING OPTIONS - THESE REBILL FOR YOUR CONVENIENCE

Monthly - $14.99
Bimonthly - $24.95
Four months- $49.95

NON-REBILLING OPTIONS - THESE PLANS DO NOT REBILL

Monthly NON rebilling - $21.99
One year NON rebilling - $129.95

______________________________________________

 

Username: ______________ Password: ___________________

(Your username may be anything you like, but we cannot guarantee the availability of common usernames, ie. Tom . Your password should be at least eight characters long and should contain both upper and lowercase letters and at least one number.)

My card will be billed as ABCD Webmasters

Signature: ___________________________

FAX TO: 434-392-5845