Application For Free Affiliate Program

Application For a Free Family Moment Account

If you are a Church, Missionary, Ministry or other Nonprofit Organization that would like to apply for a Free Family Moment Account Please fill in the form below. We will review your application and e-mail you with our decision within 1 to 3 days.

Our Free Program pays 10% Commission on any sales you have, (including 10% on your own purchases). Unlike our 3-Level Program, you will NOT earn commissions on any other stores that may sign up from your pages. Your commissions will only be from any direct customers you have.

Please note: If your Church, ministry or nonprofit organization is NOT LISTED in the business section of your phonebook, we can NOT approve you for this free program.

If you would prefer our 3-Level Program over the Free 1-Level Program offered above, simply hit "Back" on your browser and sign up for that program.

Please fill out the form completely.

Name:

Church or Business Name:

Address:

City, State, Zip:

Phone Number:

E-Mail Address

Referred By:

Website Address:

Any Other Info We Should Know:

If you prefer, either call this information in to us at: (417) 781-6710 or ...
print out this page and mail with check or money order to:
A Family Moment
P.O. Box 2153
Joplin, MO 64803

Name:
Church or Business Name:
Address:
City, State, Zip:
Phone Number:
E-Mail Address
Referred By: