Distributor: #JPB6
Name:______________________________________Date______________
Address:________________________________________
City:______________________State:_________Zip:_______
Phone:(_______)________________
Payment by: Check____ Visa____ M/C____ Amex___
Card#: _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Expires:______________
Cardholder Signature:_____________________________________
AUTHORIZATION FOR AUTOMATIC SHIPMENT:
I do authorize FLINT RIVER RANCH to automatically deliver or ship prepaid, the following products as stated.
FLINT RIVER RANCH has my permission to debit entries to my credit card for any payment due by me per this agreement.
I may cancel this authorization upon written notice to FLINT RIVER RANCH.
Automatic shipments must be set up every 30 days or more. (not less)
CODE_______ AMOUNT_______ SHIP EVERY: Month__ Other_________
CODE_______ AMOUNT_______ SHIP EVERY: Month__ Other_________
Date: _____________ Cardholder Signature:____________________________________
ESTIMATED DELIVERY TIME: 3-7 business days
| Code | Product | Price | Tax | Total* | # Bags | Extended Totals |
|---|---|---|---|---|---|---|
| FNC10 | 10 Lbs. Fish 'N Chips Dog Kibble | $16.95 | $1.31 | $18.26 | ________ | $_______ |
| BFNC20 | 20 Lbs. Fish 'N Chips Dog Kibble | $28.49 | $2.21 | $30.70 | ________ | $_______ |
| BFNC40 | 40 Lbs. Fish 'N Chips Dog Kibble | $53.49 | $4.15 | $57.24 | ________ | $_______ |
| BDOG40 | 40 Lbs. Dog and Puppy Kibble | $48.99 | $$3.80 | $52.79 | ________ | $_______ |
| BDOG20 | 20 Lbs. Dog and Puppy Kibble | $25.99 | $2.01 | $28.00 | ________ | $_______ |
| DOG10 | 10 Lbs. Dog and Puppy Kibble | $15.95 | $1.24 | $17.19 | ________ | $_______ |
| BNUG40 | 40 Lbs. Nugget Size Dog | $49.99 | $3.87 | $53.86 | ________ | $_______ |
| BNUG20 | 20 Lbs. Nugget Size Dog | $26.89 | $2.08 | $28.97 | ________ | $_______ |
| BLMR40 | 40 Lbs. Lamb-Millet-Rice Dog | $53.49 | $4.15 | $57.64 | ________ | $_______ |
| BLMR20 | 20 Lbs. Lamb-Millet-Rice Dog | $28.49 | $2.21 | $31.70 | ________ | $_______ |
| LMR10 | 10 Lbs. Lamb-Millet-Rice Dog | $16.95 | $1.31 | $18.26 | ________ | $_______ |
| DW48 | 3 lb. DryWater Dog Food | $13.99 | $1.08 | $15.07 | ________ | $_______ |
| DW48 | 9 lb. DryWater Dog Food | $37.45 | $2.90 | $40.35 | ________ | $_______ |
| PNUT4 | 4 Lbs. Peanut Butter Biscuit Treats | $11.89 | $0.92 | $12.81 | ________ | $_______ |
| LAMB4 | 4 Lbs. Lamb Biscuit Treats | $11.93 | $0.86 | $12.79 | ________ | $_______ |
| BON4 | 4 Lbs. Dog Bone Shaped Treats | $11.49 | $.89 | $12.38 | ________ | $_______ |
| Please ask about other sizes available in the Biscuit Treats | ________ | $_______ | ||||
| JW | 4 Lbs. Jubilee Wafers | $13.99 | $1.08 | $15.07 | ________ | $_______ |
| JW20 | 20 Lbs. Jubilee Wafers | $40.99 | $3.18 | $44.17 | ________ | $_______ |
| BCAT20 | 20 Lbs. Premium Cat Food | $37.99 | $2.94 | $40.93 | ________ | $_______ |
| CAT9 | 9 Lbs. Premium Cat Food | $18.95 | $1.37 | $20.32 | ________ | $_______ |
| CAT6 | 6 Lbs. Premium Cat Food | $16.49 | $1.27 | $17.72 | ________ | $_______ |
| LIT9 | 9 Lbs. Adult LITE Cat Food | $19.89 | $1.53 | $21.83 | ________ | $_______ |
| NPR | Reg Nylon Puppy Chew 4 1/2" | $2.69 | $.21 | $2.90 | ________ | $_______ |
| NR | Wolf Nylon Dog Chew 5 1/2" | $4.99 | $.39 | $5.38 | ________ | $_______ |
| NG | Nylon Giant Dog Chew 7 3/4" | $7.29 | $.56 | $7.85 | ________ | $_______ |
| FC | Frisbee Flying Disk | $11.25 | $.87 | $12.12 | ________ | $_______ |
| BF3 | Smoky Natural Bones - lamb femer w/double knots 4-6 inches | $2.78 | $.20 | $2.98 | ________ | $_______ |
| Please ask about other sizes Smoky Natural Bones | ________ | $_______ | ||||
| SS1 | Stainless Steel Bowls-No tip-Rubber Base 16 oz | $4.50 | $.35 | $4.85 | ________ | $_______ |
| SS2 | Stainless Steel Bowls-No tip-Rubber Base 32 oz | $7.95 | $.62 | $8.57 | ________ | $_______ |
| SS3 | Stainless Steel Bowls-No tip-Rubber Base 64 oz | $10.95 | $.85 | $11.80 | ________ | $_______ |
| SS6 | Stainless Steel Bowls-No tip-Rubber Base 8 oz for Cats | $3.75 | $.29 | $4.04 | ________ | $_______ |
| Total Order Amount = | $_______ | |||||
