Snail Mail and Money Order Form

Please print out the form below and mail it with your $24.95 membership fee to:
P.O. Box 1361
Dubuque, Iowa 52004-1361

(Please skip the credit card section if you will be sending a check or money order.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You can also pay by credit card by filling out the following (please print clearly):

Credti Card Number:____________________

Card Expiration Date:_______________

Name on Card:___________________

Your full name:______________________

Your primary e-mail address:________________

E-mail address to include on Smart-list:_______________

*Membership fee for the first year is $24.95 for one or
both lists.

The Smart-list website that you had been referred to
(will be something like
You must fill out this field so that your sponsor will
receive the credit for your sign-up:_____________________

If you were not referred to Smart-list by a sponsor,
please let us know how you found us:_nutra_________

You will receive a username and password to access Smart-list immediatly after your payment is received and processed.