Secure Order Form
For Smart-list.com Autoresponders

Autoesponder address to create or change:@smart-list.com

Please select one of the following:

Autoresponder Change ($5.00)

Purchase Additional Autoresponder ($5.95)

Your Name:
Your E-mail:
Username for autoresponder: @smart-list.com
(must be 3-16 characters and is also the subject of the autoresponse message)

If you have a Smart-list.com referral site, please enter it here:

Type the text that you want included in your autoresponse message below:

Please mail your check or money order to:

Smart-list.com
P.O. Box 1361
Dubuque, IA 52004-1361

OR use the secure online check form below:

-Form must be COMPLETE for your order to be processed-

(Use this graphic to help you identify data on your check)

Your Name (or Business), as it appears on check:

Your Address, as it appears on check:

Check Number (part #A):
Branch Number (part #B):
(Note: may be in small print in the upper right corner of your check)

Bank Name and Address, as it appears on check (part #D):

9-digit Transit Number (part #E):
Your Account Number (part #F):

(Please double-check your e-mail address entry before clicking SUBMIT!):
Once you hit SUBMIT your order is complete. Don't forget to enter the amount in your checkbook and reserve the Check No. which you used for this order form.

Thank You! Your order will be reveiwed and processed within the next 48 hours.