Order FormâAssociate Automatic Order
Order Form–Associate Automatic Order PAYMENT INFORMATION
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SSN OR FED. ID #
)
please complete all & sign below
ssn or fed. id no. of associate with above acct.___________________________________
name on account_________________________________ day phone
(________)______________________________
credit card number
(________)_ _________________________
LAST NAME
evening phone
FIRST NAME
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in
X
checking/savings account no.______________________
account holders name printed
checking/savings routing no._______________________
account holders billing address
exp. date
account holders signature
signature authorization box below)
“SHIP TO” INFORMATION (please pri nt) LAST NAME
SUBMITTING YOUR AUTOMATIC ORDER
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
STATE
ZIP
“SHIP TO” DAYTIME TELEPHONE
–
code
qty.
product description
BY INTERNET: Mannatech.com
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.
CITY
+
BY MAIL: Send the completed Automatic Order form with payment information to:
–
EMAIL ADDRESS:
__________________________________________________________
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
START DATE MONTH
DAY
YEAR
Begin automatic order on this date: 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 your automatic order, 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, Inc. All Rights Reserved
AUTHORIZATION
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 PHONE: Call (800) 281-4469
STREET ADDRESS (CONTINUED IF NECESSARY)
-
your signature is required
retail
assoc. cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
SUBTOTAL ____________________ ___________________
I understand that the Associate Automatic Order is optional and my credit or debit card will be charged monthly and will continue until the Mannatech Corporate Office receives either my written or verbal notification, by calling (800) 281-4469, requesting cancellation.
X____________________________________________________ signature of applicant
date
NOTE: If using a check, Mannatech must have a Direct Debit Form on file with your appropriate information. This
authorization form must be submitted by mail. Faxes cannot be accepted. Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorization 28 business days. Mannatech will charge a $20 fee for insufficient checking account balances.
RETAIL SUBTOTAL STATE & LOCAL SALES TAX: ________% X
+ ___________________
SHIPPING & HANDLING (Priority o $12.99) (Ground o $9.99) + ___________________ YOUR AUTOMATIC ORDER TOTAL
= ___________________
ORDER SHIPPED AND CHARGED EVERY 4 WEEKS. CREDIT CARD AND CHECK WITHDRAWAL ONLY.
1801601 0416 Page 1 of 2
Order Form–Member Automatic Order MEMBER INFORMATION
PAYMENT INFORMATION
)
please complete all & sign below
ssn or fed. id no. of associate with above acct.___________________________________
name on account_________________________________
o MEMBER ACCOUNT #
day phone
(________)______________________________
credit card number
(________)_ _________________________
LAST NAME
evening phone
FIRST NAME
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in
X
checking/savings account no.______________________
account holders name printed
checking/savings routing no._______________________
account holders billing address
exp. date
account holders signature
signature authorization box below)
“SHIP TO” INFORMATION (please pri nt) LAST NAME
SUBMITTING YOUR AUTOMATIC ORDER
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
code
qty.
product description
By INTERNET: Mannatech.com
BY FAX:
Fax the completed 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.
CITY
STATE
ZIP
“SHIP TO” DAYTIME TELEPHONE
–
+
BY MAIL:
Send the completed order form with payment information to:
–
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
EMAIL ADDRESS:
__________________________________________________________
START DATE AUTOMATIC ORDERS WILL BE PROCESSED UPON RECEIPT.
MONTH
DAY
YEAR
Begin automatic order on this date: 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 your automatic order, 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, Inc. All Rights Reserved
AUTHORIZATION
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 PHONE: Call (800) 281-4469
STREET ADDRESS (CONTINUED IF NECESSARY)
-
your signature is required
retail
member cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
SUBTOTAL ____________________ ___________________
be I understand that the Associate Automatic Order is optional and my credit or debit card will charged monthly and will continue until the Mannatech Corporate Office receives either my written or verbal notification, by calling (800) 281-4469, requesting cancellation.
X____________________________________________________
NOTE: If using a check, Mannatech must have a Direct Debit Form on file with your appropriate information. This signature of applicant
date
authorization form must be submitted by mail. Faxes cannot be accepted. Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorization 28 business days. Mannatech will charge a $20 fee for insufficient checking account balances.
RETAIL SUBTOTAL STATE & LOCAL SALES TAX: ________% X
+ ___________________
SHIPPING & HANDLING (Priority o $12.99) (Ground o $9.99) + ___________________ YOUR TOTAL
= ___________________
ORDER SHIPPED AND CHARGED MONTHLY. CREDIT CARD AND CHECK WITHDRAWAL ONLY.
1801601 0416 Page 2 of 2
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SSN OR FED. ID #
)
please complete all & sign below
ssn or fed. id no. of associate with above acct.___________________________________
name on account_________________________________ day phone
(________)______________________________
credit card number
(________)_ _________________________
LAST NAME
evening phone
FIRST NAME
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in
X
checking/savings account no.______________________
account holders name printed
checking/savings routing no._______________________
account holders billing address
exp. date
account holders signature
signature authorization box below)
“SHIP TO” INFORMATION (please pri nt) LAST NAME
SUBMITTING YOUR AUTOMATIC ORDER
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
STATE
ZIP
“SHIP TO” DAYTIME TELEPHONE
–
code
qty.
product description
BY INTERNET: Mannatech.com
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.
CITY
+
BY MAIL: Send the completed Automatic Order form with payment information to:
–
EMAIL ADDRESS:
__________________________________________________________
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
START DATE MONTH
DAY
YEAR
Begin automatic order on this date: 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 your automatic order, 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, Inc. All Rights Reserved
AUTHORIZATION
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 PHONE: Call (800) 281-4469
STREET ADDRESS (CONTINUED IF NECESSARY)
-
your signature is required
retail
assoc. cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
SUBTOTAL ____________________ ___________________
I understand that the Associate Automatic Order is optional and my credit or debit card will be charged monthly and will continue until the Mannatech Corporate Office receives either my written or verbal notification, by calling (800) 281-4469, requesting cancellation.
X____________________________________________________ signature of applicant
date
NOTE: If using a check, Mannatech must have a Direct Debit Form on file with your appropriate information. This
authorization form must be submitted by mail. Faxes cannot be accepted. Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorization 28 business days. Mannatech will charge a $20 fee for insufficient checking account balances.
RETAIL SUBTOTAL STATE & LOCAL SALES TAX: ________% X
+ ___________________
SHIPPING & HANDLING (Priority o $12.99) (Ground o $9.99) + ___________________ YOUR AUTOMATIC ORDER TOTAL
= ___________________
ORDER SHIPPED AND CHARGED EVERY 4 WEEKS. CREDIT CARD AND CHECK WITHDRAWAL ONLY.
1801601 0416 Page 1 of 2
Order Form–Member Automatic Order MEMBER INFORMATION
PAYMENT INFORMATION
)
please complete all & sign below
ssn or fed. id no. of associate with above acct.___________________________________
name on account_________________________________
o MEMBER ACCOUNT #
day phone
(________)______________________________
credit card number
(________)_ _________________________
LAST NAME
evening phone
FIRST NAME
❏ visa® ❏ master card® ❏ discover® ❏ american express® ❏ direct debit (for important payment information see note in
X
checking/savings account no.______________________
account holders name printed
checking/savings routing no._______________________
account holders billing address
exp. date
account holders signature
signature authorization box below)
“SHIP TO” INFORMATION (please pri nt) LAST NAME
SUBMITTING YOUR AUTOMATIC ORDER
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
code
qty.
product description
By INTERNET: Mannatech.com
BY FAX:
Fax the completed 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.
CITY
STATE
ZIP
“SHIP TO” DAYTIME TELEPHONE
–
+
BY MAIL:
Send the completed order form with payment information to:
–
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
EMAIL ADDRESS:
__________________________________________________________
START DATE AUTOMATIC ORDERS WILL BE PROCESSED UPON RECEIPT.
MONTH
DAY
YEAR
Begin automatic order on this date: 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 your automatic order, 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, Inc. All Rights Reserved
AUTHORIZATION
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 PHONE: Call (800) 281-4469
STREET ADDRESS (CONTINUED IF NECESSARY)
-
your signature is required
retail
member cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
SUBTOTAL ____________________ ___________________
be I understand that the Associate Automatic Order is optional and my credit or debit card will charged monthly and will continue until the Mannatech Corporate Office receives either my written or verbal notification, by calling (800) 281-4469, requesting cancellation.
X____________________________________________________
NOTE: If using a check, Mannatech must have a Direct Debit Form on file with your appropriate information. This signature of applicant
date
authorization form must be submitted by mail. Faxes cannot be accepted. Mannatech reserves the right to hold orders for verification of payment. Declined credit card orders will be held for authorization 28 business days. Mannatech will charge a $20 fee for insufficient checking account balances.
RETAIL SUBTOTAL STATE & LOCAL SALES TAX: ________% X
+ ___________________
SHIPPING & HANDLING (Priority o $12.99) (Ground o $9.99) + ___________________ YOUR TOTAL
= ___________________
ORDER SHIPPED AND CHARGED MONTHLY. CREDIT CARD AND CHECK WITHDRAWAL ONLY.
1801601 0416 Page 2 of 2
