Gift Marketing Alliance Web Program

Co-Branded Site Application

Yes, I want Gift Marketing Alliance to host my web site for a minimum of six (6) months. I understand that if my site is canceled for non-payment or I fail to complete the minimum (6) month agreement my account will be charged an early termination fee of $250.00 and any unpaid hosting fees. My signature authorizes Gift Marketing Alliance to charge my credit card $27(non-refundable)(yearly) for domain name registration and/or domain adjustment (if needed), $150(non-refundable) for website development and set-up, and $45(non-refundable) per month for hosting services. Furthermore, I acknowledge that I have read and accept all Terms and Conditions.

Business Name ___________________________________________________________

Sales Tax ID ____________________________________________________________

GMA Issued Member ID ________-________-________

Address_________________________________________________________________

City __________________________________________ ST _____ Zip_____________

Phone number ________________________________

E-Mail address___________________________________________________________

Signature ________________________________

Date _________________ Your State/Local Sales tax % _____________

Please check the corresponding box.

This site will be a link off of my personal site
I already have a domain name registered and want to use it for my GMA hosted site
Please register the following domain name: www.____________________________.______
     You will need to check to see that the chosen domain name is available.
     You can visit www.register.com to check for the web address availability.

If you register a domain name then you will be given the option of whether you would like to use the email account that comes with the domain name or not. You will be allotted 2 (two) different email accounts. If you require additional accounts they area available for $2 each per month. If the site is going to be a link off of your personal site you will not be able to use our webmail service. Your monthly hosting will not be decreased for this reason.

Once you have printed and completed the web enrollment form, please fax it to the
Gift Marketing Alliance office at 859-441-4240.