Contact Information...
Salutation:
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Mr.
Ms.
Mrs.
Miss
Dr.
Rev.
First Name:
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Last Name:
Company Name:
E-mail Address:
Street Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Payment Information...
Promotion Code (if any):
Mailing List Hosting Plan:
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ML Classico - $5.95 per month up to 3,000 messages
ML Piccolo - $9.95 per month up to 30,000 messages
ML Mezzo - $14.95 per month up to 50,000 messages
ML Grande - $19.95 per month up to 70,000 messages
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Payment Period:
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Bi-Annual (18 month payment, Service for 24)
Annual (10 month payment, Service for 12)
Semi-Annual (5.5 month payment, Service for 6)
Quarterly - Credit Card Customers Only
Monthly - Credit Card Customers Only
Payment Method:
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Credit Card - [Please provide info below]
Check - [An invoice will be sent via email]
Credit Card Type:
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VISA
MasterCard
American Express
Discover
Credit Card Number:
Credit Card Expiration Date:
Month
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Name on Credit Card:
Mailing List
Information...
Mailing List Name:
Your list name can contain
letters (a - z), numbers (0 - 9), the hyphen and/or the
underscore.
Your list name cannot contain spaces or characters not
listed above.
Mailing List Password:
All additional settings for
your list are configured via the web interface after
sign-up. Once your list is created, you will receive an
e-mail with the link to the interface.
Additional
Information...
How did you hear about us?
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I am a current customer.
I was referred by a current customer.
Word of Mouth
Google
Other Search Engine
Print Ad [Magazine / Newspaper]
Radio Ad
Other [Please specify below :-]
Comments,
Questions,
Special Instructions:
Acceptable Use Policy...
Please read EsoSoft's
Acceptable Use Policy ("AUP") and EsoSoft's
Privacy Statement .Select your response
to EsoSoft's AUP below.
If you choose "No" your order will not be processed.
By selecting "Yes" you
acknowledge that you have read and fully understand the
Acceptable Use Policy.
No, I do not
agree to EsoSoft's AUP.
Yes,
I have read and fully accept all the terms in the
Acceptable Use Policy.
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