Please choose your desired subscription period and fill out the requested information below.
Option 1	3 month plan - $39.00
Option 2	6 month plan - $78.00
Option 3	12 month plan - $156.00

Please give us your full name and address (required fields are bold)
First Name:		Last Name:
Address:		Apartment #:
City:		State:	Choose State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip:		Daytime Phone:
Evening Phone:		E-mail Address:

	Optional tip for independent delivery person (fill in amount). One Time Tip     Ongoing Tip With Each Payment		$
	Pay By Credit Card

When you click SUBMIT, you will be asked to preview the information you entered to make sure it is correct.