Website Membership Form Nikki Fairchild
Instructions:
Completely fill out form then print it out.
Send cashiers check or money order
and form to:
DEEROB ENTERPRISES
3301 motor avenue l.a.,ca 90034

Member Information

Name:

Address1:

Address2:

City:

State/Province:

Postal Code:

Country:

Telephone Number:

E-mail Address:

  • Reciept will be emailed. I DO NOT sell, trade, or give out any of the information you provide.
  • Your credit card billing statement will read "DEEROB ENTERPRISES"
  • Your subscription will NOT be renewed, unless you inform me otherwise. 3 or 6 month subscriptions are not renewed.


    MEMBERSHIP TYPE
    (please select one):


    Username (8 chars max.):

    Password (8 chars max.):

    Re-type Password:


    CREDIT CARD INFORMATION

    Exact Name on Credit Card:

    Credit Card Number (no spaces):

    Expiry Date:

    (mm/yy)

    Credit Card Type (please select one):

    Thank you!


    • For your convenience your one month subscription will automatically be renewed if your paying by card,
    unless you inform me otherwise. For cancellations please email me
    3 and 6 month memberships will not be renewed

    Please contact ME if you have any questions regarding this transaction.