������������� J & S Natural products

Note: Please make certified checks, Bank Draft or money order payable to: J & S Natural products

Text Box:   Name ________________________ Address _______________________________________________________   City _________________________________                      State __________ Zip/Postal code____________________   Telephone____ __________________                       Email Address (optional) __________________________     SSN#(if joining as IPC) ______________________   Date of Birth#(if joining as IPC)____________________

 

 

 

 

 

 

 

 

 

 

 

Credit Card     Money Order    Certified Check        Bank Draft

 

Credit Card # ___________________________________   Exp. Date______________________________

 

Security Code (if paying by credit card): ___________________________________

 

Card Holder Name _____________________________                                                                    Total Amount__________________________

 

 

Text Box:   Payment Method (check one):  Credit Card     Money Order    Certified Check        Bank Draft   Credit Card # ___________________________________   Exp. Date______________________________   Security Code (if paying by credit card): ___________________________________   Card Holder Name _____________________________                                                                    Total Amount__________________________    

 

 

 


 

 

 

 

 

 

 

PRODUCT NAME

QUANTITY

PRICE

(U.S. DOLLARS

 

 

 

 

 

 

 

 

 

 

To avoid delay in processing of your order, please call us at 1-800-398-3794 or email info at nonijuice dot us for correct total amount for your order before sending the payment.
 
I have accurately disclosed necessary information and I permit to use by J & S Natural Products and its employees.



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Text Box: Please fill this form and mail to:   J & S Natural products 9446 Stonebrook Dr Elk Grove, CA 95624   Please make certified checks, Bank Draft or money order payable to: J & S Natural products 

 

 

 

 

 

 

 

 

 

 

Fax: 1-413-826-4376 �������������������Phone: 1-800-398-3794����������� Email: info at nonijuice dot us