WebGenie Froogle Feed Assistant - Subscription Order Form

Store Details:
for Uploads atintervals Cost in US$

Please extend the subscription automatically before it expires.

Personal Details

Billing Details

First Name
Last Name
Admin Email
Admin Password
Contact Email (if different from above)
Phone
Fax
Business Name
Home page URL

Address Line1
Address Line2
City
State
ZIP
Country
Other Country, if not in list

Payment Details

Data Feed Details

Payment Method
Card Type
Card Number
Card Holder
Expiration Date

Card details are mandatory if 'Credit Card Online' is selected.
Otherwise, you can leave those out.

Froogle Username*

Froogle Password

Data Feed File

Comments

* If you have more than one Froogle Store accounts, give the details of the first one here. Others can be added via the admin interface after the subscription has been approved.