SpankingCentral Premium
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| Print out and mail this form along with your payment to: GPI 5757 E. Clinton Ave, STE 118 Fresno, CA 93727-1338 USA |
| (Allow 1 - 4 weeks for activation) |
Please check your choice: |
Option 1: ___ I wish to subscribe for a period of 30-days for $75.00 USD. |
Option 2: ___ I wish to subscribe for a period of 3 months (90 days) for $90.00 USD. |
Option 3: ___ I wish to subscribe for a period of 6 months (184 days) for $150.00 USD. |
Option 4: ___ I wish to subscribe for a period of 12 months (365 days) for $250.00 USD. |
| Payment enclosed: ___Cash ___Check ___Money Order ___Credit Card |
Note: U.S currency only if paying by cash, check or money order! Credit card purchases will automatically convert to other currencies based upon current conversion rates. Send cash at your own risk. |
Credit card # (VISA or Mastercard only): ___________________________________ |
| Credit Card Exp. Date: ___________ |
| CVV2 Security Code: ___________ |
| Name as it appears on Credit Card: _________________________________ |
| Allow 1 - 4 weeks for activation. Personal & business checks require an addional one-week delay for funding. I will notify you by email the same day your account is activated. Be sure to include your email address below! |
| I certify that I am at least 18 years of age (sign here):__________________ |
| Email address (PRINT VERY LEGIBLY): ___________________________ |
| Your preferred User Name: ____________ (optional) |
| Your preferred Password: ____________ (optional) |