Platinum Account
Add a New Autoresponder Via PayPal Subscriptions

Autoresponder Name
(What you want to name the autoresponder account - It will also be your Username)
Autoresponder Password
(Create your password)
First Name
Last Name
E-Mail
Website Autosponder
(The website that the autorepsonder sign-up form will be hosted on)
Address
Address cont
City
State
Zip Code
Country
Phone
Fax
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