Quarterly Connection Basic Member Application

This is what the application will look like.  You can download one from the downloads tab above.  Be SURE to write in the Sponsor’s Name, Phone Number and Code.  If you do not have any sponsor information, contact us for information.  We cannot process your application without Sponsor Information.  Any applications received without Sponsor Information will be returned.


Your Name (As you want it on your Flyer)_________________________________________________


Your Legal Name (For Commission Checks) __________________________________________


Mailing Address_____________________________________________________________________


City or Town_______________________________   State ___________Zip_____________________


Phone _______-_______-_______________ Fax (Optional) _______ – _______ – ________________


Email (Please include if you have one) ___________________________________________________


Date of Birth (Must be 18 years or older) ________________________________________________


Social Security or Tax ID Number______________________________________________________


We are aware that there is a lot of fraud out there and that this is private information.  However, in order for us to “legally” pay you commissions, we MUST have this information.  If you do not wish to provide us with your number at this time, and you want to wait until we gain your trust, this is perfectly fine.  You may “skip” it for now.  But remember that we will need this information before we can pay you commissions on your sales.  All “sensitive” information is stored in our “Locked, Fireproof Vault”!  We will NEVER share your information with anyone!


By my Signature, I certify that I have read and agree to the Terms and Conditions Agreement.



 - Payment Information –


We accept Money Orders (Preferred), Cashiers Checks or Cash – US Dollars Only


*  Note:  We are no longer accepting Personal Checks or Credit Cards.  There have been several people in the past that have given us bad checks.  Our bank charges us a $12 fee for returned checks (bad checks).  In most cases, we were unable to collect this fee back from the people who gave us the bad checks.  To make matters worse, since we pay out commissions daily, we were also out the money that we paid out in commissions.  We had similar problems with credit card charge backs.  This is why we now accept only “same as cash” funds…Money Order, Cashier’s Check or Cash.  **  Note:  If you must send cash, you do so at your own risk.  Please wrap in dark paper for added security.


Total to join:  $39.95 Quarterly.  Please enclose $39.95 for your first quarterly payment.


Circle Your Payment Method: 


_____ I enclose $39.95  - USA Members – * Money Order – Cashier’s Check – ** Cash

_____ I enclose $44.95  US Dollars – Canada and Mexico.

_____ I enclose $49.95 US Dollars – All Other Countries.

_____ Please send my order via “Priority Mail”.  I enclose an extra $5.


Mail To:  Quarterly Connection – P.O. Box 468Moffat, CO  81143



Sponsor:                                                                                         Phone:                                                                           Sponsor Code: