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Bonza Mail - Order Form          * = Required Information

Product Selection:

Qty
*Please indicate the number of mailing lists you wish to set up. Cost: $6.25 per month for each mailing list, payable annually.    

Would you like for us to customize the Bonza Mail pages that will be viewed by your subscribers to match the appearance of your existing website? Cost: $95.00 one time. If yes, please supply your existing website address:
    Yes
No

Order Total:    

Please supply the following information for each mailing list:

*Please supply a name for each list. For example: "Your Company Name Mailing List."
*What is the email address of the list owner? When emails are sent, they are sent FROM this address.
*Please supply a one or two sentence description of each list. Include in your description the purpose of the list and the frequency with which messages will be sent, so that subscribers will know what to expect.
Note: You will be able to change the above information for each mailing list at any time from your control panel.

Customer Information:

*Your Name:
Company Name:
*Address:
*City, *State:
*Zip/Postal Code:
*Country:
*Email address:
*Phone Number:

Payment Information:
Please send me an invoice:
Please charge my: VISA
VISA
MasterCard
MasterCard
AmEx
American Express
Credit Card Number:
Card ID Number: What's this?
Expiration Date (mm/yy):
Name as Printed on Card:

I have read and agree to abide by the Bonza Mail Acceptable Use Policy.


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