Obtaining your MANcheck membership by Fax or Mail:

1. Print out this form.
2. Fill in all applicable information
3. Make your cheque or moneyorder in US FUNDS to:

Diamont Company NV.

and mail it to:

  Diamont
  49 Gloucester Street,   3rd Floor
  Toronto, Ontario, Canada
  M4Y 1L8

4. OR Fax it to 416-944-3943   With your credit card information.
5. 18 YEARS of age is required for joining...  Therefore proof of age required with cheque or money order.

Please print clearly and make sure all fields are filled in.
Without a complete address we can not authorize your application and without a legible
email address we can not let you know your account is set up.

 

Referral Number: 9999
I am applying for:
Regular Membership:
1 YR with 7 days of PLUS / $19.95 ___________
2YR with 7 days of PLUS / $29.95  ___________
1YR without the PLUS / $19.95      ___________
2YR without the PLUS / $29.95      ___________
Lifetime Membership / $64.95        ___________
ManCheckPlus Membership
$49.95       _____________
Upgrade To A Plus Membership
$39.95       _____________
Upgrade To Mancheck PLUS (fill in your id/password below)
ID: ________  Password: ________
Card Holder's Name: _____________________________________________
Full E-Mail Address: PRINT CLEARLY _____________________________________________
Desired Password: _____________________________________________
Credit Card Number: _____________________________________________
CC Expiration Date: _____________________________________________
Full Mailing Address
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Card Holder's Signature: _____________________________________________

I authorize a credit card charge as indicated above for my membership to Mancheck.