Your Name:

 __________________________________________



Email Address:

 __________________________________________

Number of Months that you are paying:
$3 USA /month*
 __________________________________________

Name of the site that you are paying for:
 __________________________________________

You can get the name of a site by going to that site and looking at the address bar in your browser.

The site name is the word that follows "http://www.babyhomepages.net/"
   

* We do not accept Canadian checks, sorry.

Instructions

1) Please print this form and complete it by hand (click the "Print" button below).

2) Please make your check out to Eleven Inc. (our parent company) for any number of months that you would like the site to remain a Premium site ($3/mo USD).

3) Mail this form and your check to us at:
BabyHomePages.net
1727-8A Sardis Rd, Suite 157
Charlotte, NC 28270

Once we recieve your check we will email you a reciept. Thanks!