GroupWeb Media LLC Payment Form This form is for
GroupWeb EmailWire.Com clients who subscribe to our yearly/monthly payment
plans or other services. By
signing this form below, you agree that GroupWeb will charge your credit card
each year/month for the amount of ________ beginning from this date:
_________________________. Your card is charged same date every month for
recurring monthly plans, or on your anniversary date for the yearly recurring
plan. [ ] I am subscribing to $199 monthly
plan: I am paying today $2 setup fee plus 1st month, then later
pay $199/month for 11 months. [ ] I am subscribing to yearly plan $1500
charged today then $1500/year on your anniversary date. Payment Emailwire.com User
ID:________________ Email
Address:_______________________ ________________________________________________________________________ Comments: How did you learn about us? Any special instructions?
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