Home
Multiple Subscriptions ORDER FORM
When ordering 3 subscriptions, the 4th one is fre
e.
*
Indicates required field
Your name
*
First
Last
Your email (confidential)
*
Phone Number (confidential)
*
__________________________________
#1
Recipient's name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Recipient's email
*
Gift Note
*
__________________________________
#2
Recipient's name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Recipient's email
*
Gift Note
*
__________________________________
#3
Recipient's name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Recipient's email
*
Gift Note
*
__________________________________
#4
(free subscription)
Recipient's name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Recipient's email
*
Gift Note
*
___________________________________________
How many subscriptions total?
*
__________________________________________
CONTRIBUTION - sliding scale
2 Subscriptions: $40-80
3 Subscriptions: $60-100
4 Subscriptions: $60-100
Amount
*
$
Payment Options
*
Paypal/credit card
I will pay by check
You don't need a Paypal account to pay with a credit card via Paypal.
____________________________________________
How did you hear about us?
*
website/search engine
Positive News in print
digital Positive News
friend/family
other
Note to us
*
Submit
Home
