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ORDER FORM
Website:
Juice Plus+® Representative:
FIN:
Name:
Date:
Address:
City:
Phone:
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ZIP:
State:
E-Mail:
Method of Payment (circle one):
VISA
MC
AMEX
DISCOVER
BANK DRAFT**
(Debit or Credit)
Credit Card #:
Name on Card:
**Bank Draft
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Exp. Date:
Signature:
Checking Acct #:
Quantity
Routing #:
Juice Plus+ Products
Price
Juice Plus+® Orchard, Garden & Vineyard Blends
$71.25/month
($2.38/day)
Juice Plus+® Orchard, Garden & Vineyard Blend Chewables
$76.75/month
($2.56/day)
Juice Plus+® Complete Shake Mix
Vanilla
Chocolate
$110
($2.05/shake)
Variety (2 of each)
Juice Plus+® Complete Shake Mix - Single Serve
Vanilla
Chocolate
$127
($2.11/shake)
Variety
Juice Plus+® Complete Nutrition Bar (15 bars per box)
Spiced Apple/Raisins
Wholesome Grains/Cranberries
$32.50/month
($2.17/bar)
Variety(box of each)
____ 30 bars / 2 monthly installments ____ 60 bars / 4 monthly installments
Juice Plus+® Complete Nutrition Bar (15 bars per box)
Spiced Apple/Raisins
Wholesome Grains/Cranberries
$110
($2.17/bar)
Variety(box of each)
60 bars / 4 monthly installments
$44.50/month
($1.49/day)
Juice Plus+® Orchard & Garden Blends
Adult: $47.50/month
Juice Plus+® Chewables
($1.59/day)
Child: $24.50/month
_____ Adult Serving _____ Child Serving
($0.82/day)
Merchandise Total (Applicable Taxes Apply; Prices Subject to Change)
Shipping & Handling (AK, HI, PR, GU, US Virgin Islands: $8.50 for first carton, $7.00 per additional carton)
Order Total
I understand that my child will receive free Juice Plus+® product (capsules or chewables) for the period of one year. I agree to be a Juice
Plus+® Orchard and Garden Blend capsule or chewable customer during this period. I agree to pay shipping/handling for my product and
my child’s free product: 1 box of capsules or chewables ($1.75 monthly) or 2 boxes of chewables ($3.50 monthly).
Sponsoring Adult's Name:
Child's Name:
Child's Birthday:
College Attending (full-time undergrad):
Desired Juice Plus+® product for child:
Student's Email:
Capsules
Chewables
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