Order FormâAssociate Automatic Order - AWS
Order Form—Associate Automatic Order PAYMENT INFORMATION
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SIN OR BUSINESS #
CANADA ONLY
name on account_ day phone
)
please complete all & sign below
__________________________________ credit card number
(________)_ ______________________________
LAST NAME
evening phone
(________)_ ___________________________
FIRST NAME
®
®
®
X
chequing/savings account no.__________________________
“ship to” information (please pri nt) LAST NAME
-
exp. date
❏ visa ❏ master card ❏ discover ❏ american express ❏direct debit (for important payment information see note in signature authorisation box below) ®
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
date
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
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 Mannatech Online Documents MOD CAN1800011.
code
qty.
product description
retail
$
BY INTERNET: Mannatech.com
STREET ADDRESS CONTINUED (IF NECESSARY)
PROVINCE
POSTAL CODE
+
“SHIP TO” DAYTIME TELEPHONE
–
–
E-MAIL ADDRESS ______________________________________________________________________________________________
START DATE MONTH
DAY
$
BY FAX:
YEAR
There are 13 business periods; please indicate your choice in the space above. For clarification see MOD 1992011 BP 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 your, 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.
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
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.
$ $ $
$ $ $ $ $ $ $ $ $ $
. . . . . . . . .
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.
Shipping & Handling
X_________________________________________________________________________________
Signature of Associate Date _______________________________________ ____________________________________________ Vendor/Seller Registration No. (if applicable) Province NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorisation (see MOD 1801711) on file with your appropriate information. This authorisation form must be submitted by mail. Faxes cannot be accepted.
assoc. cost
. . . . . . . . . .
$
BY PHONE: Call (866) 717-2175
CITY
Begin on this date:
SUBMITTING YOUR AUTOMATIC ORDER
Normal $10.99 usd
GST/HST/PST X________________ + ____________________
(Discounted Total + Shipping & Handling)
YOUR TOTAL = __________________
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.
© 2013 Mannatech, Incorporated. All Rights Reserved.
1801611.060913 Page 1 of 2
Order Form—Member Automatic Order PAYMENT INFORMATION
member information o MEMBER ACCOUNT #
CANADA ONLY
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 authorization box below)
FIRST NAME
®
“ship to” information (please pri nt)
®
®
FIRST NAME
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
-
exp. date
®
chequing/savings account no.__________________________
LAST NAME
STREET ADDRESS
)
please complete all & sign below
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
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 Mannatech Online Documents MOD CAN1800011.
submitting your automatic order
code
qty.
product description
retail
STREET ADDRESS CONTINUED (IF NECESSARY)
By INTERNET: Mannatech.com
$
By PHONE: Call (866) 717-2175
$
CITY
BY FAX:
$
PROVINCE
POSTAL CODE
+
“SHIP TO” DAYTIME TELEPHONE
–
–
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.
$ $ $
BY MAIL:
E-MAIL ADDRESS ______________________________________________________________________________________________
START DATE
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
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.
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_____________________________
date
signature of member
date
*NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorisation (see MOD 1801711) on file with your appropriate information. This authorization form must be submitted by mail. Faxes cannot be accepted.
member cost
. . . . . . . . . .
$ $ $ $ $ $ $ $ $ $
. . . . . . . . . .
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
SUBTOTAL _________________
Shipping & Handling Normal $10.99 usd
GST/HST/PST X________________ + ____________________ (Discounted Total + Shipping & Handling)
YOUR TOTAL = __________________
NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation 10 business days. Mannatech will charge a $20 usd fee for insufficient chequing account balances.
© 2013 Mannatech, Incorporated. All Rights Reserved.
1801611.060913 Page 1 of 2
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SIN OR BUSINESS #
CANADA ONLY
name on account_ day phone
)
please complete all & sign below
__________________________________ credit card number
(________)_ ______________________________
LAST NAME
evening phone
(________)_ ___________________________
FIRST NAME
®
®
®
X
chequing/savings account no.__________________________
“ship to” information (please pri nt) LAST NAME
-
exp. date
❏ visa ❏ master card ❏ discover ❏ american express ❏direct debit (for important payment information see note in signature authorisation box below) ®
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
date
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
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 Mannatech Online Documents MOD CAN1800011.
code
qty.
product description
retail
$
BY INTERNET: Mannatech.com
STREET ADDRESS CONTINUED (IF NECESSARY)
PROVINCE
POSTAL CODE
+
“SHIP TO” DAYTIME TELEPHONE
–
–
E-MAIL ADDRESS ______________________________________________________________________________________________
START DATE MONTH
DAY
$
BY FAX:
YEAR
There are 13 business periods; please indicate your choice in the space above. For clarification see MOD 1992011 BP 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 your, 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.
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
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.
$ $ $
$ $ $ $ $ $ $ $ $ $
. . . . . . . . .
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.
Shipping & Handling
X_________________________________________________________________________________
Signature of Associate Date _______________________________________ ____________________________________________ Vendor/Seller Registration No. (if applicable) Province NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorisation (see MOD 1801711) on file with your appropriate information. This authorisation form must be submitted by mail. Faxes cannot be accepted.
assoc. cost
. . . . . . . . . .
$
BY PHONE: Call (866) 717-2175
CITY
Begin on this date:
SUBMITTING YOUR AUTOMATIC ORDER
Normal $10.99 usd
GST/HST/PST X________________ + ____________________
(Discounted Total + Shipping & Handling)
YOUR TOTAL = __________________
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.
© 2013 Mannatech, Incorporated. All Rights Reserved.
1801611.060913 Page 1 of 2
Order Form—Member Automatic Order PAYMENT INFORMATION
member information o MEMBER ACCOUNT #
CANADA ONLY
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 authorization box below)
FIRST NAME
®
“ship to” information (please pri nt)
®
®
FIRST NAME
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
-
exp. date
®
chequing/savings account no.__________________________
LAST NAME
STREET ADDRESS
)
please complete all & sign below
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
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 Mannatech Online Documents MOD CAN1800011.
submitting your automatic order
code
qty.
product description
retail
STREET ADDRESS CONTINUED (IF NECESSARY)
By INTERNET: Mannatech.com
$
By PHONE: Call (866) 717-2175
$
CITY
BY FAX:
$
PROVINCE
POSTAL CODE
+
“SHIP TO” DAYTIME TELEPHONE
–
–
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.
$ $ $
BY MAIL:
E-MAIL ADDRESS ______________________________________________________________________________________________
START DATE
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
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.
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_____________________________
date
signature of member
date
*NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorisation (see MOD 1801711) on file with your appropriate information. This authorization form must be submitted by mail. Faxes cannot be accepted.
member cost
. . . . . . . . . .
$ $ $ $ $ $ $ $ $ $
. . . . . . . . . .
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
SUBTOTAL _________________
Shipping & Handling Normal $10.99 usd
GST/HST/PST X________________ + ____________________ (Discounted Total + Shipping & Handling)
YOUR TOTAL = __________________
NOTE: Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorisation 10 business days. Mannatech will charge a $20 usd fee for insufficient chequing account balances.
© 2013 Mannatech, Incorporated. All Rights Reserved.
1801611.060913 Page 1 of 2
