Step-By-Step Instructions to Reserve VALUE Plan Room

Use this form to reserve a VALUE Plan Room. Requests are considered tentative and not scheduled until payment has been received. We accept PayPal using your funds either  by balance, Mastercard, Visa, Discover, Payment accepted in U.S. funds only.
**This is a single room and may not be rented out to a 3rd party.

Please fill out completely. The information you provide will be used in setting up your room.

Your Name

Your Company

Your Title
Web Site

E-mail Address
Phone
Mailing Address
City, State, Zip
Location of TMC
Button on your site

 

Welcome Page Text:
        

Background Color
           
Blue Red LiteGrn Green Purple Pink

Welcome page ( right side)* Main area is white
Bottom Info bar


Specials:
        

Drawings:
        

Information Request Form Boxes:
(ie:  Please add me to your mailing list.  Please send Hostess Info.  etc)
        

OR

Additional Pages: (you host)
1.     

URL to Your Logo: 
Referring Client/Staff Member:
         
Set up fee- All new accounts are charged a 1 time set up fee of $15
Renewals are not charged a set up fee

If you have a discount code please place it here

Payment Section

VALUE Plan:  $24.95  a year
Plus Set up fee to be included ( $39.95)


Amount Due with Set up fee included ( $24.95 + $15=$39.95)
I understand that I will receive a confirmation with total due including yearly room charge
 plus set up fee and

that my reservation has been received and that upon 
payment for one years rent, the room will be completed.  
I will then be billed automatically ( receive PayPal payment request) on my billing date for one year rent unless I give at least five (5) days notice prior to my billing date of cancellation.
** Once payment is received there are no refunds**

Check method of payment:
PayPal.com Please provide your PayPal Account for us to send a payment request to:
Mail in Check or Money Order

Note: Be sure to submit THIS form at the bottom of the page. 

Pay by Mail-In

if you wish to mail in your check or money order, please fill out all the information on this form and click the Submit Form button ONCE. Print the resulting confirmation page TWICE so that you have a copy for your records and a copy to mail with your payment.
Make your check payable to Margaret Ross and mail to:


Peggy Ross ~ The Mouse Connection
5126 Karling Pl.
Palmdale CA 93552
(661) 533-0028

Returned checks will incur a $25 service fee

 

Yes, I have read all of the above and the FAQ's
Please initial agreement of terms including non rental to 3rd parties.
We will email you within 48 business hours to verify receipt of this form.

You will be taken to a confirmation page once you submit this form.
Print a copy of the confirmation page for your copy of this transaction.