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    This document is an order form for Enagic USA water ionizer products. It requests information such as the applicant's name, address, contact details, and credit card information. The form also has sections for the sponsor's details and signature. Purchase and payment options include single payment or a payment plan over 3, 6, 10, 16, 20, or 24 months. The total cost includes unit price, tax, handling fees, and shipping charges.

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    This document is an order form for Enagic USA water ionizer products. It requests information such as the applicant's name, address, contact details, and credit card information. The form also has sections for the sponsor's details and signature. Purchase and payment options include single payment or a payment plan over 3, 6, 10, 16, 20, or 24 months. The total cost includes unit price, tax, handling fees, and shipping charges.

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    This document is an order form for Enagic USA water ionizer products. It requests information such as the applicant's name, address, contact details, and credit card information. The form also has sections for the sponsor's details and signature. Purchase and payment options include single payment or a payment plan over 3, 6, 10, 16, 20, or 24 months. The total cost includes unit price, tax, handling fees, and shipping charges.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    15 views1 page

    Download

    Uploaded by

    Mmm
    This document is an order form for Enagic USA water ionizer products. It requests information such as the applicant's name, address, contact details, and credit card information. The form also has sections for the sponsor's details and signature. Purchase and payment options include single payment or a payment plan over 3, 6, 10, 16, 20, or 24 months. The total cost includes unit price, tax, handling fees, and shipping charges.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    ENAGIC USA

    USER PRODUCT ORDER FORM


    Enagic USA, Inc.
    Headquarters
    4115 Spencer St., Torrance, CA 90503
    Phone: (310) 542-7700 / FAX: (310) 347-4447
    Distributor ID # <Do NOT Fill In>
    Toll Free: (866) 261-9500 / [email protected]
    PRINT CLEARLY
    *Applicant Information
    Legal Name (First, Middle Initial, Last) or Company Name Application Date:

    Driver's License # State Date of Birth

    Mailing Address (must match W9) City State Zip Code

    SHIP
    Phone Number Fax Number

    Cell Number Email Address

    Alternate Shipping Address City State Zip Code

    *Sponsor Information
    Sponsor Name
    REGISTER THIS APPLICANT AS YOUR [ ]A
    Under Sponsor

    Phone Number ID Number:

    ITEM ORDERED PAYMENT METHOD

    SINGLE PAYMENT Sales

    PICKUP
    $ + + = $
    Unit Price Tax Shipping Total

    Product Retail Price ENAGIC PAYMENT <**Enagic Payment System Application Required**>

    3 months 6 months. 10 months. 16 months. 20 months 24 months

    $ + + + = $
    $ Handling Tax Shipping Down Total Down

    *Credit Card Information ***COMPLETION OF ALL OF THE FOLLOWING IS REQUIRED***

    Visa Master Card Amex Discover No Diner’s Cards

    Card Number CVV # Expiration Date

    Card Holder Name (Please Print) Card Holder Signature

    Alternate Pick-Up
    Distributor Driver's License Print Name Signature (Sponsor or Buyer) Date
    Number

    *Signature
    Applicant Signature Date Sponsor Signature Date

    Do Not Sell My Personal Information (For California Residents)

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