ORDER FORM - Care Funnel
Transcription
ORDER FORM - Care Funnel
ORDER FORM Website: Juice Plus+® Representative: FIN: Name: Date: Address: City: Phone: / / ZIP: State: E-Mail: Method of Payment (circle one): VISA MC AMEX DISCOVER BANK DRAFT** (Debit or Credit) Credit Card #: Name on Card: **Bank Draft / Exp. Date: Signature: Checking Acct #: Quantity Routing #: Juice Plus+ Products Price Juice Plus+® Orchard, Garden & Vineyard Blends $71.25/month ($2.38/day) Juice Plus+® Orchard, Garden & Vineyard Blend Chewables $76.75/month ($2.56/day) Juice Plus+® Complete Shake Mix Vanilla Chocolate $110 ($2.05/shake) Variety (2 of each) Juice Plus+® Complete Shake Mix - Single Serve Vanilla Chocolate $127 ($2.11/shake) Variety Juice Plus+® Complete Nutrition Bar (15 bars per box) Spiced Apple/Raisins Wholesome Grains/Cranberries $32.50/month ($2.17/bar) Variety(box of each) ____ 30 bars / 2 monthly installments ____ 60 bars / 4 monthly installments Juice Plus+® Complete Nutrition Bar (15 bars per box) Spiced Apple/Raisins Wholesome Grains/Cranberries $110 ($2.17/bar) Variety(box of each) 60 bars / 4 monthly installments $44.50/month ($1.49/day) Juice Plus+® Orchard & Garden Blends Adult: $47.50/month Juice Plus+® Chewables ($1.59/day) Child: $24.50/month _____ Adult Serving _____ Child Serving ($0.82/day) Merchandise Total (Applicable Taxes Apply; Prices Subject to Change) Shipping & Handling (AK, HI, PR, GU, US Virgin Islands: $8.50 for first carton, $7.00 per additional carton) Order Total I understand that my child will receive free Juice Plus+® product (capsules or chewables) for the period of one year. I agree to be a Juice Plus+® Orchard and Garden Blend capsule or chewable customer during this period. I agree to pay shipping/handling for my product and my child’s free product: 1 box of capsules or chewables ($1.75 monthly) or 2 boxes of chewables ($3.50 monthly). Sponsoring Adult's Name: Child's Name: Child's Birthday: College Attending (full-time undergrad): Desired Juice Plus+® product for child: Student's Email: Capsules Chewables / /