Order FormâAssociate Automatic Order
Order Form—Associate Automatic Order PAYMENT INFORMATION
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SIN OR BUSINESS #
CANADA ONLY
name on account_ ______________________________________________ day phone
LAST NAME
)
please complete all & sign below
credit card number
(________)____________________________________________
evening phone
(________)_ _______________________________________
❏ visa ❏ master card ❏ discover ❏ american express ❏direct debit (for important payment information see note in signature authorization box at right) ®
FIRST NAME
®
®
®
chequing/savings account no.____________________________________
“SHIP TO” INFORMATION (please pri nt)
-
exp. date
X
chequing/savings routing no._____________________________________
accountholder signature
date
sin or fed. id no. of associate with above acct._____________________
LAST NAME
accountholder name printed accountholder billing address
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
STREET ADDRESS CONTINUED (IF NECESSARY)
SUBMITTING YOUR AUTOMATIC ORDER
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
BY INTERNET: Mannatech.com
CITY
$
BY PHONE: Call (866) 717-2175
PROVINCE
POSTAL CODE
E-MAIL ADDRESS ______________________________________________________________________________________________
Receive a 10% discount on the Associate cost of all products ordered on this form. DAY
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:
10% DISCOUNT * Begin on this date:
$
BY FAX:
“SHIP TO” DAYTIME TELEPHONE
MONTH
retail
$
YEAR
There are 13 business periods; please indicate your choice in the space above. For clarification see MOD 1992011
IMPORTANT: Unless a specific business period is request-
ed, 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.
Send the completed Automatic Order form with payment information to: MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
authorization
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. 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.
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 Authorization (see MOD 1801711) on file with your appropriate information. This authorization form must be submitted by mail. Faxes cannot be accepted.
$ $ $
assoc. cost
. . . . . . . . . .
$ $ $ $ $ $ $ $ $ $
. . . . . . . . . .
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
Shipping & Handling
Normal
$6.99 usd
SUBTOTAL _________________
10% DISCOUNTED PRICE ____________________ Multiply subtotal by .90
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 authorization 10 business days. Mannatech will charge a $20usd fee for insufficient chequing account balances.
© 2011 Mannatech, Incorporated. All Rights Reserved.
1801611.122011 Page 1 of 2
Order Form—Member Automatic Order PAYMENT INFORMATION
member information o MEMBER ACCOUNT #
)
please complete all & sign below
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 at right) ®
FIRST NAME
®
®
®
chequing/savings account no.____________________________________
“ship to” information (please pri nt)
-
exp. date
X
chequing/savings routing no._____________________________________
accountholder signature
date
sin or fed. id no. of associate with above acct._____________________
LAST NAME
accountholder name printed accountholder billing address
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.
submitting your automatic order
code
qty.
product description
retail
STREET ADDRESS CONTINUED (IF NECESSARY)
By INTERNET: Mannatech.com
$
CITY
By PHONE: Call (866) 717-2175
$
BY FAX:
$
PROVINCE
POSTAL CODE
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.
“SHIP TO” DAYTIME TELEPHONE
E-MAIL ADDRESS ______________________________________________________________________________________________
10% DISCOUNT Members receive a 10% discount on the Member cost of all products ordered on this form.
AUTOMATIC ORDERS WILL BE PROCESSED UPON RECEIPT.
Begin Automatic Order on this date:
MONTH
DAY
$ $ $
BY MAIL:
Send the completed order form with payment information to:
$
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
$
GST# 899910038RM0001
$
YEAR
IMPORTANT: Unless a specific date is re quested, 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.
$
authorization
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
*NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorization (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).
Shipping & Handling
Normal
$6.99 usd
SUBTOTAL _________________
10% DISCOUNTED PRICE ____________________ Multiply subtotal by .90
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 authorization 10 business days. Mannatech will charge a $20 usd fee for insufficient chequing account balances.
© 2011 Mannatech, Incorporated. All Rights Reserved.
1801611.122011 Page 2 of 2
ASSOCIATE INFORMATION ❏ ACCOUNT # ❏ SIN OR BUSINESS #
CANADA ONLY
name on account_ ______________________________________________ day phone
LAST NAME
)
please complete all & sign below
credit card number
(________)____________________________________________
evening phone
(________)_ _______________________________________
❏ visa ❏ master card ❏ discover ❏ american express ❏direct debit (for important payment information see note in signature authorization box at right) ®
FIRST NAME
®
®
®
chequing/savings account no.____________________________________
“SHIP TO” INFORMATION (please pri nt)
-
exp. date
X
chequing/savings routing no._____________________________________
accountholder signature
date
sin or fed. id no. of associate with above acct._____________________
LAST NAME
accountholder name printed accountholder billing address
FIRST NAME
STREET ADDRESS
(USE THIS LINE AND THE NEXT LINE BELOW IF MORE SPACE IS NEEDED)
STREET ADDRESS CONTINUED (IF NECESSARY)
SUBMITTING YOUR AUTOMATIC ORDER
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
BY INTERNET: Mannatech.com
CITY
$
BY PHONE: Call (866) 717-2175
PROVINCE
POSTAL CODE
E-MAIL ADDRESS ______________________________________________________________________________________________
Receive a 10% discount on the Associate cost of all products ordered on this form. DAY
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:
10% DISCOUNT * Begin on this date:
$
BY FAX:
“SHIP TO” DAYTIME TELEPHONE
MONTH
retail
$
YEAR
There are 13 business periods; please indicate your choice in the space above. For clarification see MOD 1992011
IMPORTANT: Unless a specific business period is request-
ed, 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.
Send the completed Automatic Order form with payment information to: MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
authorization
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. 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.
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 Authorization (see MOD 1801711) on file with your appropriate information. This authorization form must be submitted by mail. Faxes cannot be accepted.
$ $ $
assoc. cost
. . . . . . . . . .
$ $ $ $ $ $ $ $ $ $
. . . . . . . . . .
All amounts in U.S. dollars and are subject to GST/HST/PST(where applicable).
Shipping & Handling
Normal
$6.99 usd
SUBTOTAL _________________
10% DISCOUNTED PRICE ____________________ Multiply subtotal by .90
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 authorization 10 business days. Mannatech will charge a $20usd fee for insufficient chequing account balances.
© 2011 Mannatech, Incorporated. All Rights Reserved.
1801611.122011 Page 1 of 2
Order Form—Member Automatic Order PAYMENT INFORMATION
member information o MEMBER ACCOUNT #
)
please complete all & sign below
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 at right) ®
FIRST NAME
®
®
®
chequing/savings account no.____________________________________
“ship to” information (please pri nt)
-
exp. date
X
chequing/savings routing no._____________________________________
accountholder signature
date
sin or fed. id no. of associate with above acct._____________________
LAST NAME
accountholder name printed accountholder billing address
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.
submitting your automatic order
code
qty.
product description
retail
STREET ADDRESS CONTINUED (IF NECESSARY)
By INTERNET: Mannatech.com
$
CITY
By PHONE: Call (866) 717-2175
$
BY FAX:
$
PROVINCE
POSTAL CODE
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.
“SHIP TO” DAYTIME TELEPHONE
E-MAIL ADDRESS ______________________________________________________________________________________________
10% DISCOUNT Members receive a 10% discount on the Member cost of all products ordered on this form.
AUTOMATIC ORDERS WILL BE PROCESSED UPON RECEIPT.
Begin Automatic Order on this date:
MONTH
DAY
$ $ $
BY MAIL:
Send the completed order form with payment information to:
$
MANNATECH, INCORPORATED 600 S. ROYAL LANE, STE. 200 COPPELL, TX 75019
$
GST# 899910038RM0001
$
YEAR
IMPORTANT: Unless a specific date is re quested, 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.
$
authorization
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
*NOTE: If using a direct debit Mannatech must have a Chequing/Savings Account Withdrawal Authorization (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).
Shipping & Handling
Normal
$6.99 usd
SUBTOTAL _________________
10% DISCOUNTED PRICE ____________________ Multiply subtotal by .90
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 authorization 10 business days. Mannatech will charge a $20 usd fee for insufficient chequing account balances.
© 2011 Mannatech, Incorporated. All Rights Reserved.
1801611.122011 Page 2 of 2
