Hosting Subscription Agreement

Hosting Subscription Agreement:

Please enter your plan and payment details below. Print and either fax form or mail to address listed at the end of this form. By signing you understand and agree to the following:

1.) By providing my credit card details below, I am authorizing RL Hanson-Online to charge my credit card on a recurring basis until I request a cancellation of my hosting services.

2.) I can cancel at any time by calling 785-238-7777 and speaking to an account manager, by e-mailing support@rlhanson-online.com or by sending a cancellation request to 727 Oak Hill Drive, Chapman, KS 67431.

3) I understand, RL Hanson-Online will notify me by e-mail of the charge billed to my card and forward a receipt for the transaction.

4.) I understand that in the event of the credit card charge being declined, I must provide an alternative payment method with 14 days to avoid a suspension of my hosting service and website or email.

First Name
Last Name
Company
E-Mail Address or Current Website

Hosting Package

Hosting Plans

Credit Card Information (as it appears on your credit card statement or billing account): IMPORTANT: If you just made a payment through our online store, your card will not be charged until your next billing cycle!
First Name	(Include your middle initial if shown on your card.)
Last Name
Street Address:
City:
State:		Zip:
Telephone:		Mobile:
Credit Card Type:
Number:		CRV:	(Last 3 or 4 digits on back)
Expiration Date:	(mm/dd/yyyy)
I prefer NOT to be enrolled in Subscriptions - please process my payment manually.
Signed:		Date:

Fax form to: (816) 984-1550 or send by mail: 727 Oak Hill Drive, Chapman, Kansas 67431