Please print this form, complete the form and mail it to:

UtahSingles.com
8192 Sugar Creek Way
West Jordan, Utah 84088


Type of Membership

New Membership
Renewal
Your Profile Name:

Membership Term

One Month Full Membership $14.95
Three Month Full Membership $29.95 (20% Off!)
Six Month Full Membership $47.95 (30% Off!)
One Year Full Membership $71.95 (50% Off!)

How did you hear about us?
Your First and Last Name:

Street Address:

City:

State:

Postal Zip Code:

Daytime Phone:

E-Mail Address:

Payment Method
:  Check or Money Order Credit Card

Credit Card Information

*Credit Card Type: Visa MasterCard American Express
Credit Card Number:
Card Expiration: Month:
Year:


Signature_________________________________________

Please double check to make sure you have entered all your information correctly. 


Salt Lake Singles | Ogden Singles | Provo Singles | Sandy Singles | Riverton Singles | Park City Singles

Local Links | Dating Affiliates

SEARCH PROFILES | FREE TRIAL MEMBERSHIP | FREE NEWSLETTER

Home | Help/FAQ's | Join | About Us | Success Stories | Your MailBox | Post-A-Photo

Dating Tips | Site Map | Advertisers | Search Profiles | Submit FREE Profile | Our Privacy Policy

Copyright © 1995 - 2007 UtahSingles.com LLC. All rights reserved.