DEWA Secure Order Form


Becoming a member of DEWA and advertise here at DEWA are easy. Just fill out the form below: This secure form will encrypt your personal information. You must use Netscape Navigator or Microsoft Internet Explorer in order to access this form.


INSTRUCTIONS:
You must provide your real first and last name, and email address for all orders -- all other blanks must be filled in as well. Your user name and password are both case sensitive.
Choose Order

Member

3 month US$20.00 6 month US$30.00

Advertising

US$300.00 US$225.00 US$150.00


Account Information

First Name
Last Name
E-mail


Credit Card

Visa Master Card American Express

Card Number:

Cardholder's Name:

Expiration Date (MMYY):


User Name and Password

User Name (8 Characters):

Password (8 Characters):

Confirm Password:

User Agreement

  1. I agree to pay the above listed charges and acknowledge that all sales are final and no refunds will be given unless a technical problem exists which prevents access to the site.

  2. I understand that my credit card account will be billed by "DEWA Network" and all customer service and billing inquiries should be directed toward DEWA Network by emailing billing@dewa.com

  3. I understand that if I do not receive a password within 72 hours of submitting my application there is most likely a problem and I must contact webmaster@dewa.com for more information.

  4. WARNING: Credit card theft and fraud will be prosecuted to the fullest extent of the law.