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For no credit cards order order form with wire-transfer, online banking or payment by Mail:Please send only Money for cash Order.Payment must be in US Dollars drawn on a US bank or in EURO:
The following fields with
*
you must fill out all
:
My Privacy Guarantee: I do not release any information.
Send the respective amount with Wire Transfer,also called Tele-Transfer in some countries to our Bank-account (you see the international bank account-number after you submit this form):
The membership-accounts will be setup at the same day payment arrives to our bank-account. Please include your email address, username or name(bill).
*
Select
the duration of the membership:
*
1-Month Euro 15.-
2-Months Euro 27.-
3-Months Euro 39.-
Euro=European-currency
Personal data:
*
First Name(optional):
*
Last Name(optional):
*
born-date: (year)
*
Your email@.com
*
City and or state
:
*
Country:
*
Your username
:
(
6-12 max. characters in length
)
*
password of your choice
(6-12 max. characters in length)
comment:
Transfer / Ueberweisung
By Cash,Checks or Money order
Western Union
please check the form again before you send it to me.
When you clicking on the submit button,wait few second for the confirm site
© 2008 by Hotleg
