PRINT THIS FORM.  Please complete the following form. Required fields ( * ) are:  Name,  address, city, state/providence, country (USA or Canada, Zip or  Post Code, Primary Telephone, E-Mail Address, & membership level.  PLEASE PRINT CLEARLY!!

 

* Name:  __________________________________________

 

* Address: _________________________________________

 

* City: ____________________________________________

 

* State/Providence: _____________                                    * Zip Code / Postal Code: ______________    

* Country: USA / Canada                                                     * Primary Phone: _____________________

 

* Primary Email Address: ____________________________________

Cell/Mobile Phone: _______________________                 Work Phone: _________________  Ext: _______

Referred by? ___________________________________

Input referrer's Membership ID  if you would like them to get credit for referring you to us. (it is their email address)

 

* Form of Payment:
Check or Money Order [  ] Check (US) or Money Order (US or Canada). Canada MO must be drawn upon US bank only.
Credit Cards: [  ] Visa  [  ] Mastercard   [  ] Discover   [  ] American Express

Card #: ___________________________________________   Expiration Date: __________

3 Digital Security Code on back of card: __________  
Issuer of Card, ie Citi Bank, Advanta, etc.): _______________ Card Issuer’s Toll Free Phone #: ______________

Cardholder’s Signature: __________________________

Address given above must be the billing address for your credit card. If not, please pay by Money Order. Thank you!

Questions or Concerns, please email us at: info@geturgadget.com

Membership Agreement

    By joining our service,  you agree that you have read our Program Overview page, agree to our Terms of Service to include Limitations and Exclusion of Service.  You agree you are 18 years of age or older, and are a resident of the United States or Canada.

    You may cancel your membership at any time as outlined under our Terms of Service.  We offer a 30 Day Money Back Guarantee with the Gold Membership, which you are entitled to any refunds as long as you qualify for refund as outlined in our Terms of Service on the Program Page. Contact us if you wish to cancel your membership, or have any questions or concerns before doing so.  GetUrGadget.com may make changes to the Terms of Service as deemed appropriate, and will email members any changes, to include updates and corrections.

Please make payable and send to:

Unicom Information Services
1609 Cottonwood Drive

Lewis Center, OH 43035