Member agreement form_us_en
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This document is a member application and agreement for Javita International Ltd. It outlines the application process which can be completed online, by fax, or phone. If applying by phone, the application must be sent within 10 days or the agreement will be void. The application collects contact and identification information and requires a $49.95 application fee plus annual renewal fee of $14.95. It details an optional autoship program and pack options for joining that provide different product quantities and qualifications for bonus programs. Applicants must agree to the terms and conditions in the policies and procedures.
Member agreement form_us_en
- 1. Member Application & Agreement To apply, you may complete an online application at www.javita.com or you may fax this completed form. If you apply by phone you must send the application to us within 10 days or the agreement will be void. Send to: Javita International Ltd at 7835 NW Beacon Square Blvd., Boca Raton, FL 33487. Phone: 1-855-JAVITA-1 (1-855-528-4821) Fax: 1-561-258-2341 Street Address (Current Mailing Address) City Enrolling Members # or Federal Tax ID # Name (Last, First, Middle Initial) Sponsoring Members # or Federal Tax ID # Name (Last, First, Middle Initial) I understand the only financial requirement to become a Javita Member is a $49.95 application fee (plus any applicable tax) which includes a kit containing sales and demonstration materials and company information produced by Javita Inc. I understand this kit does not contain commissionable products and any products purchased in connection with becoming a Member are optional. I have read and agreed to the Policies & Procedures (online), and am familiar with the Javita exchange policy found in the Policies & Procedures, and agree with the terms and conditions, which by reference are fully incorporated into this agreement. In addition, a yearly renewal fee of $14.95 is required to continue as a Javita Member. A PARTICIPANT IN THE JAVITA INTERNATIONAL LTD. COMPENSATION PLAN HAS THE RIGHT TO CANCEL AT ANY TIME, FOR ANY REASON. CANCELLATION MUST BE SUBMITTED IN WRITING TO JAVITA AT ITS PRINCIPAL PLACE OF BUSINESS. (faxed copies may be deemed as originals) Item # 11001 0512 (please PRINT all information clearly) Sole proprietorship Corporation Partnership Social Security # (or Federal Tax ID# for Business Entity only) Birth Date (MM/DD/YY) Applicant Signature Todays Date (MM/DD/YY) The Enroller is the Member who is recruiting an individual to be a Member with Javita. The Enroller may also be the Sponsor. The Sponsor is the immediate upline of the newly enrolled Member. If the Sponsor is the same as the Enroller, leave these fields blank. Cardholders Name (Last, First, Middle Initial) Expiration Date (MM/YY) This convenient program allows you to receive an automatically generated order each month from Javita. Cancellation of an AutoShip Order must be done through Javita Member Services at least five business days prior to your scheduled ship date. Select from the options below if you wish to be part of Javitas AutoShip Program: Credit Card Security Code (3 or 4 digits) Authorization Signature o 4 boxes (96 sticks) coffee $120 (100 PV) $20 savings on AutoShip o Other: number of boxes _____ x $35 = __________ o 2 boxes (48 sticks) coffee $70 (50 PV) AutoShip/Program Drop5 Join Packs *If applying under a business name, additional information is required. Contact Javita Member Services at 1-855-JAVITA-1. Name (Last, First, Middle Initial) or Business Name* Area Code Daytime Phone Number Co-Applicant/Spouse or Business Contact (if applicable) Mobile Number State Country Zip Code Email Mastercard速 Visa速 Discover速 American Express速 o Business Elite Pack ..................... $999 (900 PV) Javita energy + mind coffee (32 boxes) Javita-Branded Coffee Tumbler Javita Sample Sleeves (100 pk) Javita Member Kit By joining with this pack, you are eligible to participate in our STAR Bonus and Car Bonus Programs, have the Rank Advancement Bonus qualifications waived and enjoy 5-level FastStart Bonus. o Business Pack ........................... $499 (400 PV) Javita energy + mind coffee (14 boxes) Javita-Branded Coffee Tumbler Javita Sample Sleeves (100 pk) Javita Member Kit By joining with this pack, you are eligible to participate in our STAR Bonus and Car Bonus Programs, have the Rank Advancement Bonus qualifications waived and enjoy 5-level FastStart Bonus. o Starter Pack ....................... $99 (50 PV) Javita energy + mind coffee (2 boxes) Javita-Branded Coffee Tumbler Javita Member Kit o Member Kit only ........................ $49.95