Please fill out this form completely and select the Submit button.

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

For delivery information, please see the information following this form.

Lifetime Reminder Service Order Form

Name and Address must be the same as it is on your Credit Card Statement

Street Address:
City, State, Zip: ,
Phone: (Include Area Code)
Reminder Kits Requested:
Payment Type MasterCard Visa
Credit Card number exp:

Delivery Information:

USA - Regular delivery: please allow 7 to 10 working days.