CampaignActive Website System

Secure Sign-up Form

Welcome to the CampaignActive secure sign-up form! You can use this form to sign-up for a CampaignActive website, or to request a free demo of the CampaignActive system. The information you submit below will not be shared with anyone, and will only be used for purposes of establishing a service account for your CampaignActive website. Complete the form and click the preview button to confirm your information. Once we receive your information, a service representative will contact you to begin setting up your CampaignActive website. Thank you!
CONTACT INFORMATION
Campaign: *
Mailing Address: *
City: * State/Province: *
Postal Code: * Country: *
Phone: * Fax:
   
Contact Person: *
Phone: * Cell Phone:
Email Address: *
I would like to just schedule a free demo of the CampaignActive system at this time.
   
WEBSITE INFORMATION - If you are ready to purchase a CampaignActive website complete the information areas below.
I am ready to order a CampaignActive website package!
Please choose the package you want from the drop down:
 
Choose a Template Layout:
View Template Layouts
   
Choose a Template Color Skin:
View Color Skins
   
Do you have a Logo for the website?
(Click the browse button to select the logo from your computer)
 
What would you like for the main website header text?
(Example: Elect Ronald Smith)
 
What would you like for a smaller sub header text?
(Example: Serving the city of Glendale since 2000)
 
Enter the domain name to use for this website:
(Example: www.elect-ron-smith.org)
 
Does your organization already own this domain name?
Does your organization run an in-house email server?
   
If you have any initial requests or
questions, please enter them here:
PAYMENT OPTIONS
How do you prefer to pay the one time
- CampaignActive package setup fee?		 *
 
How do you prefer to pay the recurring
- CampaignActive web hosting fee?		 *
   
If you selected Credit Card above, select Card Type:
Enter Card Number:
(NO dashes or spaces)
Enter Card Code:
(3-4 digit card verification number on back of card)
Select Card Expiration Date:
   
Click the Preview Order button once to continue. You will be able to confirm your order on the next page. You order is being submitted via encrypted transaction (SSL) for your protection.

(* Required Fields)