AdorationPro Sign Up Form (EAC)

Referral by eucharisticadorationcanada.com

Organization Name
(Only the main name is needed. You do not need include "parish, school, church, chapel", etc.
Example: St. Mary's) *
Name of Person Managing the Product
(Website Manager, Adoration Coordinator, Reservation Admin, etc) Name of Person Managing the Product
(Website Manager, Adoration Coordinator, Reservation Admin, etc) * Title First Last Suffix
Name of Person Managing the Product
(Website Manager, Adoration Coordinator, Reservation Admin, etc) Name of Person Managing the Product
(Website Manager, Adoration Coordinator, Reservation Admin, etc) * First Last
Email of Person Managing the Product *
Phone of Person Managing the Product
(for church members to use)
Mobile Phone for person managing product
(for Parish Solutions Co. to use for a text message to let you know when the product is ready.) *
Current Website Address
Which Product(s) are your ordering?
(price includes 5% EAC discount for first year) *

Which Product(s) are your ordering?
(price includes 5% EAC discount for first year) AdorationPro - $52/month (for 30 hours or more of adoration per week) AdorationPro - $33/month (for fewer than 30 hours of adoration per week)
Referring Organization - (Admin Use Only)
City where organization is located *
Country where organization is located *
State/Province/Region where organization is located *
I would like to pay *

I would like to pay monthly by credit/debit card (automatic recurring charge - cancel anytime) annually by credit/debit card annually by check/cheque
Email (For invoices and receipts) *
Phone for Accounts Payable (if different than above) Phone for Accounts Payable (if different than above) - ### - ### ####
Name on Card Name on Card * First Last
Card Number *
Expiration Date *
CVC/CVV Code *
Zip Code with Card *
Send Annual Invoice To Attention of: *
Address to send Annual Invoice Address to send Annual Invoice
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country