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Private Citizen, Inc.
PO Box 233
Naperville, IL  60566
630-393-2370  e-mail
To join on-line:    click here
Print this form to Cut Junk Calls / Cut Junk Mail.
Fill it in and send it to us with your membership fee.
We will then have your legal authorization to Cut Junk Calls / Mail for you.
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Junk Calls - Send me Private Citizen's membership materials to cut junk calls; and Notify over 1,500 local and national telemarketing firms, that: "I hereby adopt the Notice and Offer (linked here ) as my own and appoint Private Citizen, Inc. as my agent to send it to entities involved in telephone solicitation, advising them of my  Notice and Offer, as well as my name, city, state, zip code and phone number/s." 
In brief, it states that you: 
- are unwilling to freely receive junk phone calls, and consider them an invasion of privacy,
- offer junk callers the use of your phone and/or time, on a for-hire basis of $500 per call,
 - define a junk call as one intended to solicit sales, donations, survey data or political support.
 
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Junk Mail - S end me Private Citizen's membership materials to cut junk mail and include The Ultimate Junk Mail Weapon.  Also, copy my Notice that: "I do not want unsolicited junk mail. Remove my name from all  mail, direct marketing lists or directories you compile, control or influence. You may tell other firms of my request. A copy of this Notice is as valid as an original."   Then, as my agent, send this Notice to: 

Donnelley Marketing
Direct Marketing Assn.		 Trans Union, Inc.
R.L. Polk & Co.		 Abacus Direct
ADVO Systems		 Haines & Comp.
Acxiom, Inc.
c.c.: U. S. House of Representatives  -  Committee on Government Reform & Oversight
 
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Your Information
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Print Name (ex. spouses, John / Jane Doe)

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Street Address or P.O. Box

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Location (City, State & Zip)

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List an extra person / firm for an added $5

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List an extra address - add $5

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List an extra Location
________________________________________________________          __________________
SIGN Here (a representative of the residence or business must sign)                    Date

(_____) ______-__________            (_____ )______- __________       (_____) ______-__________
 Enter phone / fax / cell number                          List additional numbers for an added $5 each
To protect unlisted phones, the Private Citizen Directory lists numbers and names in separate tables.
 
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Membership Options
Initial
Here:_____		 To: Cut Junk Calls  Basi c membership 
$ 2 0 ______
Initial
Here:_____ 		 To: Cut Junk Mail   Basic membership
$ 1 0 ______
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Add $5 for each  extra; Name, Address, Phone    ___
x
 $
5= ______
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Book (non-members = $10 / members = $5)
$

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Total make payable to Private Citizen, Inc.
$

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Card # ___________________________________    Exp. Mo__ Yr__
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Snail-mail to:
Private Citizen        PO Box 233        Naperville, IL 60566

 
Are there specific firms you want us to notify?  Give us their name, address and phone number.
All Material © Copyright 1988 - 2002 by Private Citizen, Inc.