- ORDER FORMâASSOCIATE AUTOMATIC ORDER
ORDER FORM — A SSOCIATE AU TOM ATIC ORDER PAYMENT INFORMATION
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SIN OR BUSINESS #
CANADA ONLY
name on account_________________________________ day phone
credit card number
(________)______________________________
LAST NAME
evening phone
(________)_ _________________________
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in signature authorisation box below)
FIRST NAME
“SHIP TO” INFORMATION (please pri nt) LAST NAME
FIRST NAME
STREET ADDRESS
)
please complete all and sign below
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
X
account holder's signature
chequing/savings routing no.______________________________
account holder's name printed
sin or fed. id no. of associate with above acct._ _______________
account holder's billing address
SUBMITTING YOUR AUTOMATIC ORDER
code
qty.
product description
retail
POSTAL CODE
+
“SHIP TO” DAYTIME TELEPHONE
EMAIL ADDRESS ______________________________________________________________________________________________
START DATE
Begin automatic order on this date:
MONTH
DAY
YEAR
There are 13 Business Periods; please indicate your choice in the space above. For clarification, see Mannatech Online Document Business Period Calendar.
$
IMPORTANT: Unless a specific Business Period is
requested, the initial order will be shipped after verification of payment. Every Business Period thereafter, orders will be generated on or about every 28 days from the creation date of, or after verification of payment. This will create 13 shipments per calendar year, one in each four-week Mannatech Business Period. Mannatech will recalculate your order total if inaccurate and make any necessary corrections.
© 2016 Mannatech, Incorporated. All Rights Reserved.
$
BY FAX:
Fax the completed Automatic Order form to (800) 825-6584. Include payment information with your order. If ordering by fax, do not fax twice or mail hard copy of order to Mannatech.
$
BY MAIL:
$
$ $
Send the completed Automatic Order form with payment information to: MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
authorisation
. . . . . . . . . .
$
BY PHONE: Call (866) 717-2175
CITY
date
To fill in this portion of the order form, please refer to the prices in the Mannatech Product Guide. If you do not have a guide, you can download a current product price list from the Mannatech Resource Library.
BY INTERNET: mannatech.com
STREET ADDRESS CONTINUED (IF NECESSARY)
PROVINCE
chequing/savings account no._____________________________
-
exp. date
your signature is required
As an independent distributor I hereby certify that this purchase is, and all subsequent purchases will be, for the sole purpose of resale, and undertake that in the event any such purchases are converted to personal use or consumption, that I will self-assess and remit any applicable provincial sales tax.
$ $ $
$ $ $ $ $ $ $ $
. . . . . . . . . .
SHIPPING AND HANDLING
X_________________________________________________________________________________
Signature of Associate Date _______________________________________ ____________________________________________ Vendor/Seller Registration No. (if applicable) Province
NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation 28 business days. Mannatech will charge a $20usd fee for insufficient chequing account balances.
$
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
I understand that the Automatic Order is optional and will continue until the Mannatech corporate office receives either my written or verbal notification, by calling (866) 717-2175, requesting cancellation.
NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorisation on file with your appropriate information. This authorisation form must be submitted by mail. Faxes cannot be accepted.
assoc. cost
$
Normal $10.99 usd
GST/HST/PST X________________ +______________
(Discounted Total + Shipping and Handling)
YOUR TOTAL = __________________
1801611.0416 Page 1 of 2
ORDER FORM — MEMBER AU TOM ATIC ORDER PAYMENT INFORMATION
MEMBER INFORMATION CANADA ONLY
o MEMBER ACCOUNT #
name on account_________________________________ day phone
LAST NAME
credit card number
(________)______________________________
evening phone
(________)_ _________________________
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in signature authorisation box below)
FIRST NAME
“SHIP TO” INFORMATION (please pri nt) LAST NAME
FIRST NAME
STREET ADDRESS
)
please complete all and sign below
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
chequing/savings account no._____________________________
X
account holder's signature
chequing/savings routing no.______________________________
account holder's name printed
sin or fed. id no. of associate with above acct._ _______________
account holder's billing address
SUBMITTING YOUR AUTOMATIC ORDER
STREET ADDRESS CONTINUED (IF NECESSARY)
By INTERNET: mannatech.com
CITY
By PHONE: Call (866) 717-2175
PROVINCE
+
“SHIP TO” DAYTIME TELEPHONE
code
qty.
product description
______________________________________________________________________________________________
START DATE
$ $
Fax the completed form to (800) 825-6584. Include payment information with your order. If ordering by fax, do not fax twice or mail hard copy of order to Mannatech.
$ $ $
Send the completed order form with payment information to:
$
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
$ $
GST# 899910038RM0001
AUTOMATIC ORDERS WILL BE PROCESSED UPON RECEIPT.
Begin automatic order on this date:
MONTH
DAY
$
YEAR
There are 13 Business Periods; please indicate your choice in the space above. For clarification, see Mannatech Online Document Business Period Calendar.
IMPORTANT: Unless a specific date is requested, the initial order will be shipped after verification of payment. Every month thereafter, orders will be generated on or about the same date as your original Automatic Order, after verification of payment. This will create 12 shipments per calendar year. Mannatech will recalculate your order total if inaccurate and make any necessary corrections.
© 2016 Mannatech, Incorporated. All Rights Reserved.
retail
$
BY MAIL:
EMAIL ADDRESS
authorisation
your signature is required
I understand that the Member Program is optional and my credit or debit card will be charged monthly and will continue until the Mannatech Corporate Office receives either my written notification or my verbal notification, by calling (866) 717-2175, showing either termination or a change in the order.
X_____________________________
signature of member
date
To fill in this portion of the order form, please refer to the prices in the Mannatech Product Guide. If you do not have a guide, you can download a current product price list from the Mannatech Resource Library.
BY FAX:
POSTAL CODE
-
exp. date
date
*NOTE: If using direct debit, Mannatech must have a Chequing/Savings Account Withdrawal Authorisation on file with your appropriate information. This authorisation form must be submitted by mail. Faxes cannot be accepted. NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation for 10 business days. Mannatech will charge a $20 usd fee for insufficient chequing account balances.
. . . . . . . . . .
member cost
$ $ $ $ $ $ $ $ $ $
. . . . . . . . . .
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
SUBTOTAL _________________ SHIPPING AND
HANDLING Normal $10.99 usd
GST/HST/PST X________________ + ____________________ (Discounted Total + Shipping and Handling)
YOUR TOTAL = __________________
1801611.0416 Page 2 of 2
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SIN OR BUSINESS #
CANADA ONLY
name on account_________________________________ day phone
credit card number
(________)______________________________
LAST NAME
evening phone
(________)_ _________________________
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in signature authorisation box below)
FIRST NAME
“SHIP TO” INFORMATION (please pri nt) LAST NAME
FIRST NAME
STREET ADDRESS
)
please complete all and sign below
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
X
account holder's signature
chequing/savings routing no.______________________________
account holder's name printed
sin or fed. id no. of associate with above acct._ _______________
account holder's billing address
SUBMITTING YOUR AUTOMATIC ORDER
code
qty.
product description
retail
POSTAL CODE
+
“SHIP TO” DAYTIME TELEPHONE
EMAIL ADDRESS ______________________________________________________________________________________________
START DATE
Begin automatic order on this date:
MONTH
DAY
YEAR
There are 13 Business Periods; please indicate your choice in the space above. For clarification, see Mannatech Online Document Business Period Calendar.
$
IMPORTANT: Unless a specific Business Period is
requested, the initial order will be shipped after verification of payment. Every Business Period thereafter, orders will be generated on or about every 28 days from the creation date of, or after verification of payment. This will create 13 shipments per calendar year, one in each four-week Mannatech Business Period. Mannatech will recalculate your order total if inaccurate and make any necessary corrections.
© 2016 Mannatech, Incorporated. All Rights Reserved.
$
BY FAX:
Fax the completed Automatic Order form to (800) 825-6584. Include payment information with your order. If ordering by fax, do not fax twice or mail hard copy of order to Mannatech.
$
BY MAIL:
$
$ $
Send the completed Automatic Order form with payment information to: MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
authorisation
. . . . . . . . . .
$
BY PHONE: Call (866) 717-2175
CITY
date
To fill in this portion of the order form, please refer to the prices in the Mannatech Product Guide. If you do not have a guide, you can download a current product price list from the Mannatech Resource Library.
BY INTERNET: mannatech.com
STREET ADDRESS CONTINUED (IF NECESSARY)
PROVINCE
chequing/savings account no._____________________________
-
exp. date
your signature is required
As an independent distributor I hereby certify that this purchase is, and all subsequent purchases will be, for the sole purpose of resale, and undertake that in the event any such purchases are converted to personal use or consumption, that I will self-assess and remit any applicable provincial sales tax.
$ $ $
$ $ $ $ $ $ $ $
. . . . . . . . . .
SHIPPING AND HANDLING
X_________________________________________________________________________________
Signature of Associate Date _______________________________________ ____________________________________________ Vendor/Seller Registration No. (if applicable) Province
NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation 28 business days. Mannatech will charge a $20usd fee for insufficient chequing account balances.
$
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
I understand that the Automatic Order is optional and will continue until the Mannatech corporate office receives either my written or verbal notification, by calling (866) 717-2175, requesting cancellation.
NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorisation on file with your appropriate information. This authorisation form must be submitted by mail. Faxes cannot be accepted.
assoc. cost
$
Normal $10.99 usd
GST/HST/PST X________________ +______________
(Discounted Total + Shipping and Handling)
YOUR TOTAL = __________________
1801611.0416 Page 1 of 2
ORDER FORM — MEMBER AU TOM ATIC ORDER PAYMENT INFORMATION
MEMBER INFORMATION CANADA ONLY
o MEMBER ACCOUNT #
name on account_________________________________ day phone
LAST NAME
credit card number
(________)______________________________
evening phone
(________)_ _________________________
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in signature authorisation box below)
FIRST NAME
“SHIP TO” INFORMATION (please pri nt) LAST NAME
FIRST NAME
STREET ADDRESS
)
please complete all and sign below
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
chequing/savings account no._____________________________
X
account holder's signature
chequing/savings routing no.______________________________
account holder's name printed
sin or fed. id no. of associate with above acct._ _______________
account holder's billing address
SUBMITTING YOUR AUTOMATIC ORDER
STREET ADDRESS CONTINUED (IF NECESSARY)
By INTERNET: mannatech.com
CITY
By PHONE: Call (866) 717-2175
PROVINCE
+
“SHIP TO” DAYTIME TELEPHONE
code
qty.
product description
______________________________________________________________________________________________
START DATE
$ $
Fax the completed form to (800) 825-6584. Include payment information with your order. If ordering by fax, do not fax twice or mail hard copy of order to Mannatech.
$ $ $
Send the completed order form with payment information to:
$
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
$ $
GST# 899910038RM0001
AUTOMATIC ORDERS WILL BE PROCESSED UPON RECEIPT.
Begin automatic order on this date:
MONTH
DAY
$
YEAR
There are 13 Business Periods; please indicate your choice in the space above. For clarification, see Mannatech Online Document Business Period Calendar.
IMPORTANT: Unless a specific date is requested, the initial order will be shipped after verification of payment. Every month thereafter, orders will be generated on or about the same date as your original Automatic Order, after verification of payment. This will create 12 shipments per calendar year. Mannatech will recalculate your order total if inaccurate and make any necessary corrections.
© 2016 Mannatech, Incorporated. All Rights Reserved.
retail
$
BY MAIL:
EMAIL ADDRESS
authorisation
your signature is required
I understand that the Member Program is optional and my credit or debit card will be charged monthly and will continue until the Mannatech Corporate Office receives either my written notification or my verbal notification, by calling (866) 717-2175, showing either termination or a change in the order.
X_____________________________
signature of member
date
To fill in this portion of the order form, please refer to the prices in the Mannatech Product Guide. If you do not have a guide, you can download a current product price list from the Mannatech Resource Library.
BY FAX:
POSTAL CODE
-
exp. date
date
*NOTE: If using direct debit, Mannatech must have a Chequing/Savings Account Withdrawal Authorisation on file with your appropriate information. This authorisation form must be submitted by mail. Faxes cannot be accepted. NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation for 10 business days. Mannatech will charge a $20 usd fee for insufficient chequing account balances.
. . . . . . . . . .
member cost
$ $ $ $ $ $ $ $ $ $
. . . . . . . . . .
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
SUBTOTAL _________________ SHIPPING AND
HANDLING Normal $10.99 usd
GST/HST/PST X________________ + ____________________ (Discounted Total + Shipping and Handling)
YOUR TOTAL = __________________
1801611.0416 Page 2 of 2
