Customer Interest Form

1
American Patriot Social - Introduction 1A freedom of speech platform of truth, trust, integrity and transparency. We are a free speech platform for all Patriots from of all political stripes and all different origins. No matter the color of your skin, your ethnic background, or your political party affiliation, you will be welcome to join our platform to speak freely and engage in active discussions without restriction of your first amendment rights. We are a platform that honors the law of freedom of speech and the freedom of expression that is granted to us not by man and not according to a document but by Almighty God according to His supreme law because true freedom is only found in God through His Son Jesus Christ. American Patriot Social is more than just a freedom of speech platform. It is a movement. A movement of true freedom of speech and expression and a movement to take control of our nation by putting the power back into the hands of WE THE PEOPLE. A movement that encourages free speech, independent thought, and rejecting political censorship. A movement to unite all Americans with the rest of the world. As a member of American Patriot Social, not only will you be able to speak freely without restriction, you will also be a part of the foundation of our movement to help build a new system of freedom and liberty with the intention and purpose of making the old system of censorship, control and manipulation obsolete. OUR VISION AND MISSION ARE SIMPLE: To defend the rights and freedoms of all people, support Christian values & beliefs, promote free speech, free thought, the free flow of information without restriction and give people the freedom to speak and share the truth based on the facts. Our platform was founded on the core principles of truth according to the written Word of God. And ye shall know the truth, and the truth shall make you free. John 8:32 (KJV)
2
American Patriot Social - Introduction 2Main Page of the Platform...
3
Name* This field is required.
First Name
Last Name
4
Phone Number* This field is required.
Area Code
Phone Number
5
Email* This field is required.
example@example.com
6
City / State
Street
Apt / Suite
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
How would you like to be contacted* This field is required.
Phone Call
Text Message
Email
8
Question #1* This field is required.If you had the opportunity to purchase products that are safer for your family and your home while not supporting or buying from the big box stores and instead from an American Patriot company, how would that make a difference for you?
Huge
Large
Normal
Small
Ok
Ok
9
Question #2* This field is required.What are your thoughts on how the big box stores are trying to censor and silence those who are standing for the truth and the impact you believe it is making in our nation and the way we buy the products we need and use every day?
Huge
Large
Normal
Small
Ok
Ok
10
Question #3* This field is required.How do you believe buying products from an American Patriot wellness club can help benefit our country, our economy and our freedom?
Huge
Large
Normal
Small
Ok
Ok
11
Question #4* This field is required.How would it help you and your family to learn more about the options available for natural wellness solutions in your daily lives?
Huge
Large
Normal
Small
Ok
Ok
12
How did you find us / hear about us?* This field is required.Please select one
American Patriots Forum (Website)
American Patriot Intel & News (Telegram)
American Patriots Forum Rumble Channel (Website)
American Patriot Social (Website)
From a friend
Other
13
Additional Information (Optional)
Huge
Large
Normal
Small
Ok
Ok
14
Please be sure to schedule an appointment with us!* This field is required.NOTE: You can schedule your appointment after you submit the form!
Ok!
Should be Empty: