Keep And Bear Arms.com Mail-In Membership/Contribution Application

Print and Mail this form to:
KeepAndBearArms.com
12500 N.E. Tenth Place, Bellevue, WA 98005 
Telephone: (425) 454-7012

Enclosed is my contribution to help preserve my right to Keep And Bear Arms.

Contribution Options: (check one)

_____ $10            _____ $25                _____ $50
_____ $75            _____ $100              _____ Other $ ______

Membership Options: (check one)

Which of the following are you choosing?  (check one)

_____ 1-year $29.95            _____ 1-year Senior Citizen (55 and over) $24.95
_____ 2-year $54.95            _____ 3-year $79.95
_____ 5-year $119.95          _____ Distinguished (Senior Citizen) Life $295
_____ Life $495

New Members/Contributors (Please choose user name and password)

Preferred User Name  1. ___________  2.  ___________  3.  ___________

Chosen password (can be changed by you later)  _______________

_____ Please send me notification by email when my account is activated.

Life Payment Plans

Life payment plans are available only by credit card.  My signature below indicates acceptance of credit card debiting for the duration of the commitment I am making at this time.

_____ Monthly life � $20 per month for 30 months, plus $50 to start.
______ Quarterly Life $50 every 3 months for 3 years, plus $50 to start.

* Please note: Each monthly payment includes a billing fee of $3.50 and each quarterly payment includes a billing fee of $8.75. Please contact AccountInfo@KeepAndBearArms.com at any time to complete the payment of your membership and avoid future billings and fees.

_____  I would like my credit card to be billed on ___________ (date) and on that same approximate date as each payment becomes due.

Mr. Mrs. Ms. (circle one)

______________________________________________________
Name (please print)

______________________________________________________
Address

______________________________________________________
City / State / Zip

______________________________________________________
Telephone Number

______________________________________________________
FAX number

______________________________________________________
E-mail address  (IMPORTANT!!! This is how we will notify you 
that your membership has been processed. If you don't have
email, we provide free email account. Go get one.)

Please charge my   __Visa   __MC    in the amount of $________

______________________________________________________
Card number

______________   ______________________________________
Exp. Date             Signature (required on credit card purchases)

Check number _______ is enclosed in the amount of $________.

Please allow 5-10 business days to be notified by email or postal mail that your account has been activated. Please make check payable to KeepAndBearArms.com.

Thank you for helping us grow and improve.

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