Subscription Form

Name.........................:
Street Address............:
Second Address..........: (optional)
City............................:... State :... Zip Code :
Phone Number............: (optional)
Amount Enclosed........:... Senior Citizen:... New......Renewal...:

Subscription ID.........:

(If renewal, enter the 6 digit number located in the upper right hand corner of your mailing label in the Subscription ID box.)

Fill out the form above and print this page with the print button below.
Mail the form

(boxed area only) with your check to:

YOUR COMMUNITY SHOPPER
P.O. Box 249
Ardmore, TN 38449-0249