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Internet Enrollment Form

Please enroll me as a member in FACT and send my

Membership Kit to the address shown below.
I understand that my one year dues ($36), will be fully refunded if I change my mind for any reason and return my Membership Kit within 30 days after I join.


Name

Address

City

State

Zip

Telephone

e-mail


to charge the fully refundable one-year dues ($36.00) to your MasterCard or Visa account


IF YOU WOULD LIKE TO PAY BY CHECK

PRINT AND MAIL
THIS ENROLLMENT FORM TO:

FACT Membership Office
318 Hillsboro Avenue, PO Box 104
Edwardsville, IL 62025

ENCLOSE YOUR CHECK OR MONEY ORDER FOR THE $36 ONE-YEAR DUES, PAYABLE TO FACT.


Whether you mail your Enrollment Form or submit it via the internet, we suggest that you print this page as a record of the transaction. You will receive an e-mail confirmation of your enrollment. Enrollments are typically processed within two working days after they are received by the Fact Membership Services Office.
IF YOU HAVE QUESTIONS OR YOU EXPERIENCE DIFFICULTY WITH THIS INTERNET ENROLLMENT FORM, SEND US AN e-mail OR CALL 1-800-USA-FACT
FACT has negotiated favorable agreements on behalf of its members with reputable benefit providers, all of whom assume full responsibility for their programs. Availability, scope and suppliers of these benefits are subject to change without notice, and some restrictions and limitations may apply. Any member who experiences a problem should contact FACT's Consumer Hotline immediately.