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 Renewal  New Subscription
Company name: ______________________________________________
Your name: __________________________________________________
Address: ____________________________________________________
City: _______________________________________________________
Province: _________________________ Postal Code: _______________
E-mail: _____________________________________________________
Telephone No: (_____) __________________
Date: ________________________________
Web Site Title: ______________________________________________
Web Site URL: http://_________________________________________
Web Site Description (maximum 15 words):
___________________________________________________________
___________________________________________________________
___________________________________________________________
One Year Subscription = CAD 24.00 + 1.68 GST (7%) = $25.68
G.S.T. #888433661
Credit Card Type: VISA MasterCard
Name on Card:______________________________________________
Cardholder Address:__________________________________________
___________________________________________________________
Credit Card #:_______________________ Expiration Date:___________
Last 3 digits of number printed on back of the credit card:____________
Signature:______________________________ Amount: $____________
Note: Your account will only be debited once your link has been accepted. We retain the right to refuse links to websites (at our own discretion and without justification) of and/or with links to web sites of misleading, illegal and/or non-family oriented content. Website content must fall within acceptable guidelines through the contract period (family safe, etc). Links will be removed without compensation if content is changed to illegal, misleading or non-family safe content after your link is accepted.
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