Javita product order_autoship_form_us_en
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Item # 11007 0812 All faxed copies may be deemed as originals. Product Order / AutoShip Form To set-up an AutoShip Order or submit an order, fill out the form below and fax to our office. Send to: Javita International Ltd. at 7835 NW Beacon Square Blvd, Boca Raton, FL 33487. Phone: 1-855-JAVITA-1 (1-855-528-4821) • Fax: 1-561-258-2341 Member / Customer Information Street Address (Current Mailing Address) City Name (Last, First, Middle Initial) or Business Name Area Code Daytime Phone Number State Zip Code E-mail Address Member / Referral Number Applicant Signature Today’s Date (MM/DD/YY) Payment Information ❍ Mastercard ® ❍ Visa ® ❍ Discover ® ❍ American Express ® Cardholder’s Name (Last, First, Middle Initial) Expiration Date (MM/YY) Credit Card Security Code (3 or 4 digits) Authorization Signature Order / AutoShip Information By selecting AutoShip you authorize the company to automatically ship your monthly order and collect the appropriate funds each month. Please supply ALL required information. Orders are subject to the local sales tax of your region and will be added to your order total. Shipping & handling charges will also be added. AutoShip orders are billed each month coinciding with your monthly order date. Note: Your first order will be processed upon approval of this application, and subsequent orders will fall into the regular AutoShip billing & shipping schedule beginning the following month. Be sure to check "AutoShip" if you'd like to make this a recurring monthly order. All orders will be billed / shipped upon Javita's receipt of your order. Description Price Qty PV Total Cost Burn + Control Power Kit (4 boxes of burn + control coffee.) Enjoy a $20 savings off retail when you put this Kit on AutoShip. Energy + Mind Power Kit (4 boxes of burn + control coffee.) Enjoy a $20 savings off retail when you put this Kit on AutoShip. Combo Power Kit (2 boxes of each variety.) Enjoy a $20 savings off retail when you put this Kit on AutoShip. Burn + Control Basic Kit (2 boxes of burn + control coffee.) Energy + Mind Basic Kit (2 boxes of energy + mind coffee.) Combo Basic Kit (1 box of each variety.) * Total does not include applicable tax or shipping and handling. Total* o Make this an AutoShip Order o Change my AutoShip Order
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Transcript of Javita product order_autoship_form_us_en
Item # 11007 0812All faxed copies may be deemed as originals.
Product Order / AutoShip FormTo set-up an AutoShip Order or submit an order, fill out the form below and fax to our office. Send to: Javita International Ltd. at 7835 NW Beacon Square Blvd, Boca Raton, FL 33487.
Phone: 1-855-JAVITA-1 (1-855-528-4821) • Fax: 1-561-258-2341
Member / Customer Information
Street Address (Current Mailing Address) City
Name (Last, First, Middle Initial) or Business Name Area Code Daytime Phone Number
State Zip Code E-mail Address Member / Referral Number
Applicant Signature Today’s Date (MM/DD/YY)
Payment Information
❍ Mastercard® ❍ Visa® ❍ Discover® ❍ AmericanExpress®
Cardholder’sName(Last,First,MiddleInitial) ExpirationDate(MM/YY)
CreditCard SecurityCode(3or4digits) AuthorizationSignature
Order / AutoShip Information
By selecting AutoShip you authorize the company to automatically ship your monthly order and collect the appropriate funds each month. Please supply ALL required information. Orders are subject to the local sales tax of your region and will be added to your order total. Shipping & handling charges will also be added. AutoShip orders are billed each month coinciding with your monthly order date.
Note: Your first order will be processed upon approval of this application, and subsequent orders will fall into the regular AutoShip billing & shipping schedule beginning the following month.
Be sure to check "AutoShip" if you'd like to make this a recurring monthly order. All orders will be billed / shipped upon Javita's receipt of your order.
Description Price Qty PV Total Cost
Burn + Control Power Kit (4 boxes of burn + control coffee.)Enjoy a $20 savings off retail when you put this Kit on AutoShip.
Energy + Mind Power Kit (4 boxes of burn + control coffee.) Enjoy a $20 savings off retail when you put this Kit on AutoShip.
Combo Power Kit (2 boxes of each variety.) Enjoy a $20 savings off retail when you put this Kit on AutoShip.
Burn + Control Basic Kit (2 boxes of burn + control coffee.)
Energy + Mind Basic Kit (2 boxes of energy + mind coffee.)
Combo Basic Kit (1 box of each variety.)
* Total does not include applicable tax or shipping and handling.
Total*
o Make this an AutoShip Order o Change my AutoShip Order
JAVITA MEMBER
TERMS AND CONDITIONS. PLEASE READ THOROUGHLY. As a participant in the Javita AutoShip Program, I authorize Javita Inc. ("Javita") to ship my order to me monthly after processing the payment method that I have indicated. Javita is under no obligation to ship any products until full payment has been received. Shipment will take place approximately two days from payment confirmation.
1. AUTOSHIP: All new AutoShip Agreements received will generate an order to be shipped within two days of receipt. Each month thereafter, your AutoShip order will be sent on or about the same time each month. Orders received between the 21st and end of month will be sent on or about the 20th of each month.
2. SHIPPING AND HANDLING: All AutoShip orders are shipped via ground shipping. Shipping and handling charges applied to each AutoShip order are as follows: 5.75% of the order subtotal with a minimum of $7.50.
3. REVISION: You may revise your AutoShip Agreement monthly. To do so, submit a new AutoShip Form and check the box labeled "Change my AutoShip" or modify your agreement online by visiting www.javita.com. Javita Support must have revisions no later than 5 business days prior to your next AutoShip shipment date. If the revision is received less than 5 business days prior to shipment, there will be no guarantee that the revision will be effective for that shipment. The revised application will be in effect for the next shipment date.
4. CANCELLATION: If a Member decides to cancel their AutoShip, a signed notification must be submitted to Javita Member Services. Member Services must have cancellation notice no later than 5 business days prior to your next AutoShip shipment date. If the cancellation is received less than 5 business days prior to shipment, there will be no guarantee that the order will not ship.
5. RETURNS: Prior to any product being returned to Javita, a Return Merchandise Authorization (RMA) Number must be issued. Please contact Javita Support to receive an RMA by calling 855-JAVITA-1 (1-855-528-4821).
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