Fax: 1-416-849-0441
Registration for a GTAstore
Client Information
Company Name:_________________________________________________________
Web Address:_________________________________________________________
Street:_________________________________________________________
City:_________________________________________________________
Province/State:_________________________________________________________
Postal/Zip Code:_________________________________________________________
Office Phone Number:_________________________________________________________
Office Fax Number:_________________________________________________________
Contact Person:_________________________________________________________
Contact Phone Number:_________________________________________________________
Cell Phone Number:_________________________________________________________
Package Details
Limited Time
Promotional Offer:
  1. Package A: set-up fee $99.00 + monthly hosting $15.00
  2. Package B: set-up fee $149.00 + monthly hosting $12.00
  3. Package C: set-up fee $199.00 + monthly hosting $10.00
  • Full amount is due annually at start of period
  • Money Back Guarantee if not satisfied within 10 days of purchase
  • Hosting can be cancel at any time, fee of remaining months will be refunded.

Payment Information
Payment Type:
Visa
MasterCard
American Express
Paypal
Money Order
Cheque
Cash
Others _______________

* Invoice will be sent by postal mail.

Card Number:___________________________
Card Expiration:____/______(MM/YYYY)
3 or 4 Digit Code at Back of Card:_______________
Name Exactly as it Appears on Card:_________________________
Card Holder Address:___________________________
City:___________________________
State/Province:__________________________
Postal/Zip Code:_____________________
Country:_______________________
Phone:_________________________
Email Address:__________________
Amount Charged To Credit Card:$________
Signature of Card Holder:_____________________________
Signature:___________________________/ Date:____________(MM/DD/YYYY)
 
GTAstore.com
Tel: 1-416-333-3266   Fax: 1-416-849-0441
Email: info@gtastore.com - Website: http://www.GTAstore.com