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CBA Membership Enrollment Form
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First Name
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Middle Initial
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Last Name
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Address 1
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Address 2
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City
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State (XX)
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Zipcode
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Phone (Home/Mobile - 0000000000)
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Phone (Work - 0000000000)
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Email Address
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Password
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    Strength: Very Weak
    Payment Method
    Credit Card Number
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    Expiration Month
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    Expiration Year
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    CVV Code
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    How you want to pay?
    I (We) hereby authorize Consumer Benefits of America (CBA) to initiate recurring monthly charges of $11.95 to my (our) credit/debit card indicated above for membership in CBA. This authority is to remain in full force and effect until CBA has received written notification from me (us) of its termination. Membership in CBA will then terminate on the payment due date. You may contact CBA at benefits@consumerbenefits.com or by calling 800-707-8339 between 8:00 a.m. and 5:00 p.m. MST.

    Please Note: Please allow 1 business day for your membership Login to become effective.

    Again, welcome and thank you for your interest in the Consumer Benefits of America membership program.
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