Builder Interest Form

1
Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Area Code
Phone Number
3
Email* This field is required.
example@example.com
4
City / State
Street
Apt / Suite
City
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Other
Country
5
How would you like to be contacted?* This field is required.
Phone Call
Text Message
Email
6
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?
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7
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?
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8
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?
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9
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?
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10
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
11
Additional Information (Optional)
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