Lifetime Reminder Service Order Form




To order your membership kit complete the order form below and mail it to:

J & D Enterprises
P.O. Box 1118
Uniontown, Ohio 44685

Credit Card orders may be faxed to: (330) 699-0326

Send me ____ Lifetime Reminder Kits @$29.00 each Total _________

Name____________________________________

Address__________________________________

City/State/Zip_____________________________

Phone (including area code)___________________

Method Of Payment

Payment (circle one) ... Check ... Money Order ... VISA ... MasterCard

Name on Credit Card_____________________________
Account Number: ________________________________
Expiration Date:__________
Signature______________________________________
Make check or money order payable to: J & D Enterprises


Allow 2-4 weeks for delivery. Orders will be shipped same day if paid by Credit Card or Money Order. All checks will be processed and cleared prior to shipping membership kit.