SUBSCRIPTION FORM FOR BUSINESSES 

Name and position of person completing form: ___________________________________

Name of Business:   _______________________________________________________

Name of Business Owner: __________________________________________________

Business Address: _____________ City: _______________ State: _________ Zip ______

Mailing Address: _______________City:_______________ State: _________ Zip ______

Phone: ( ______ )____________________Extra Phone: (______)___________________

Email address:___________________________ __FAX:__________________________

Web Page Address:_______________________________________________________

Discount or Special you will Honor:____________________________________________

____Buy a regular Business Membership                                     # of Cards       Subtotal

                   One Lifetime Business Membership Card $20.00 each: ______       ______

                        Purchase Extra Lifetime Memberships $20.00 each: ______       ______

____Join as a business member and be added to the Special

                  Business Guide all at once you pay one price of $90.00: ______       ______

____Adding business at a later date to the

                                 Special Guide list you pay additional:  $75.00: ______       ______

____Have us develop and Host Web Page for your business

                                                                First year fee is $125.00: ______       ______

____Renewing Web Page succeeding years are $10.00  per month: ______       ______

                                                                       or $100.00 per year:______        ______

____Business Member or one of their employees to buy

                                           Additional Life time cards $10.00 each:______       ______

____Buy cards for Business fundraiser

                                 One Year Discount Smart Card $10.00 each: ______       ______

____10 card set of One Year Discount Smart Card for Employee

                                                 Christmas Bonuses $40.00 per set: ______       ______

____Become a CSC Discount “Smart Card” Representative    

                      One Year Card Membership Card cost $10.00 each:______       ______

                                 Lifetime Membership Card cost $25.00 each: ______       ______

____As a CSC Representative purchase set of 5 cards to resale

                                            Purchase a 5 card set for $20.00 each:______       ______

                                          (A Rep can resale these at $10.00 each)

____Purchase  your  Protected  Area  Contract  (PAC)  for  $250: ______       ______

____Get paid for cards sold when you link to our web page

                                  On One Year Card you are paid $3.00 each: ______       ______

                                  One Life time cards you are paid $8.00 each: ______       ______

          The buyer must identify an assigned code given to your link

_____Purchase Special Occasion One Year Membership Cards

                          The first Special Occasion  Card cost you $10.00: ______       ______

              For additional Special Occasion cost you only $5.00 each: ______       ______

                                                                                            Total # of Cards    Total Cost

                                                                                                       ______       ______

Please indicate where you heard about the CSC Discount Smart Card.__________________

_______________________________________________________________________

If you learned about the card from our Web Page or another, please provide the reference

 code they provided so we can give credit to the appropriate sources.

Make check or money order out to CONSUMER SAVERS CLUB.

Mail form with check or money order to:  CSC Smart Card

                                                                      Box 2922

                                                                Lawton, OK 73502