Digital Newsletter Order Form

Please fill out the following Information. Note: Entries marked with a * are required.

Step 1: Enter Your Contact Information
   
*Name:
 (first and last)
*Company Name:
Title:
*Address:
*City:
*State/Province:
*Postal Code:
 
*E-mail:
*Phone:
Step 2: *Enter Your Setup Information
Do not customize my newsletter (no photo, logo, contact information). Skip to Payment Preferences
New/Change setup - please fill out information below (you will receive a proof of your setup)
  There is a one-time setup fee of $15 for the Digital Newsletter
 
New/Change Setups: Please list what contact information you would like to have on your layout. Due to space constraints, up to 3 pieces of contact information is recommended.
Contact Info #1:
Contact Info Examples:
 

"Office: 303-460-1027"
"Toll Free: 800-433-3755"
"Fax: 303-460-7427
"Email: info@intouchtoday.com"
"Website: www.mycompany.com "
Tagline
Address

Contact Info #2:
Contact Info #3:
   
Photo/Logo Customization:
Add My Logo
Add My Photo
   
Add the Following Specialty Logos:
   
This is a Joint Setup (two people listed) - fill out the below contact information.
Marketing Partner's Name:
Marketing Partner's Company:
Marketing Partner's Contact Information:
 
Add my marketing partner's logo
Add my marketing partner's photo
Step 3: Payment Preferences
*Payment Information
My payment information is on file.
Charge a new credit card number. Download a credit card authorization form
 
*Payment Choice
Charge my card monthly ($35 if personalized, $30 if not personalized. Total cost for 12 months paid monthly: $420)
I would like to pay 12 months in advance and save $60 (Total cost for 12 months prepaid: $360)
Notes/Comments About Your Order:
Call me for further details
Email me about the details of this order
 
Coupon Code (if applicable):
 
How did you hear about In Touch Today?

Clicking the "Place Order" button authorizes your order
For pricing inquiries please call our toll free line at 1-800-433-3755