Referral Registration Form

Fill out all information. 

Check the appropriate box to select the service of your choice.

Name: ___________________________________________________________

Address: (not for publication)__________________________________________

City:  ___________________ State:  ______  Zip: ______Phone: _____________

E-Mail Address:  __________________________________________________

Website Address: (if choosing plan B)___________________________________

Please check the subscription you would like:

Plan A = 1 year subscription-$99.00_____

Plan B = 1 year subscription with hyperlink to your website-$124.00_____

We accept MasterCard, Visa, American Express, and Discover.

Please make check or money orders payable to Donna's Designs, Inc.

Credit Card#_______________________________________ Exp.  _________

Signature:   ______________________________________________________

Site will list the following:  Name

                                                Company Name

                                                Business Telephone number

                                                E-mail Address

Website Link (if applicable)

Office use only:  Starting date: ________________Renewal date : ________________