Subscription Application Form

http://www.everydayqi.com

Secure Subscription Form

We respect your privacy. The personal information requested below is for use in processing your credit card, which is done with secure encryption. We never reveal, share, or sell member information. For complete details see our Privacy Statement.

Customer Information

* = Required - Must match credit card billing address!

First Name [ required ]
Last Name [ required ]
Company
Address Line 1[ required ]
Address Line 2
City [ required ]
State [ US & Canada ]
State/Province [ All other Countries ]
Zip/Postal Code [ required ]
Country [ required ]
Your E-mail Address [ required ]
Phone or Fax Number [ required ]

Subscription Options

Subscription Plan:	EveryDay Qi Charter Pre-launch Trial Membership - for only $9.97 A full THREE months uninterrupted access to the EveryDay Qi Membership Site! ($29.97 Value) If at any time you want to cancel your membership, just go to www.EveryDayQi.com, log-in to your account and cancel OR email support@everydayqi.com with the words STOP CHARGE in the subject line, and we will stop charging your credit card immediately. EveryDay Qi Charter Trial Membership ($9.97) After your three month trial charter period, your credit card will be charged automatically every month ($9.97) and you will be sent a receipt. Cancel anytime. As long as you remain a member in good standing, your low charter rate will NEVER increase, no matter how much content we continue to add.

Choose LOGIN Name [ required ]

Choose PASSWORD [ required ]at least six characters long, using alphas and numbers, no spaces.

Confirm PASSWORD [ required ]

Payment Information

Payment Method [ required ]
Credit Card Number [ required ]
Credit Card Security Code [ required on (MC/Visa) ? ]
Expiration Date [ required ]	/
Name on Credit Card [ required ]
Is this a Renewal?
<<< Please Check The Box to acknowledge that you have read and understood our terms of use.


NOTE: It can take up to a minute to process the credit card information and obtain approval. Please do not press the submit button multiple times - doing so could cause double billing.
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