SendUs.To/YourName Web Address Registration Form

Managed By: B.B.D.S. Computers
#8 5907 4th Avenue
Edson, Alberta -- T7E 1L9 -- Canada
Phone: 1-888-671-9165 -- Fax: 1-888-803-9484
E-Mail: sendushelp@bbdsedson.com
WWW: http://SendUs.To

Note: You may use the Automatic E-Mail button to submit this form OR you may fax the form to the above number. We may take up to 48 hours to update the Expire-Date on your account. However, your account will not be deleted as long as this form has been submitted. Please retain a copy of this form for your records. No other Invoice will be issued.

SendUs.To URL -- SendUs.To/
Company Name:
Contact Name:
Contact Phone:
Contact E-Mail:
Country:

1 Year Rental and Forwarding
($100.00 Canadian Funds):

G.S.T. or H.S.T. if you are in Canada:

Total:
VISA Card Holder Name:
VISA Card Number:
VISA Card Exp. Date:
Comments: