Magazine Subscription Form
Design 3

 

Customer Details

First Name

Last Name

Email

Phone

Address Line 1

Address Line 2

City/Town

State/Province

Zip/Postal Code

Country

 

Topic Selection:

Magazine

Select?

Yearly Fee

A
B
C
1
Sports Weekly Mania
$120.00
2
Men's Health
$144.00
3
Business Weekly
$240.00
4
Fast Cars Mania
$120.00
5
Holiday Wonders
$144.00
6
 
 
 
7
If you select more than one magazine, you get monthly fee discount of $10 x number of magazine.
 
$0.00

Please select the billing frequency: You get a further 5% discount for quarterly billing or 10% discount if you pay yearly. 

Total payment:

$0.00

Billing frequency:

Annual Saving:

$0.00

% saving:

0


Thank you for subscribing to our magazines!


To configure an element, select it on the form.

To add a new question or element, click the Question & Element button in the vertical toolbar on the left.