THUNDER ORDER FORM

First Name: Last Name: Member #: Phone: Email:

AUTOSHIP YES (repeat ea. mo.) NO (one time only)

*24 8.4 oz. cans per case.

1 Case* $48 $55

CV 24 24

Qty

Total Price (plus shipping)**

/per month

**Actual shipping will be charged. Est. $18 East Coast $11 West Coast. Shipping discounts for multiple orders.

Payment Information:
(select one)

Wallet Balence (Orders with insufficient balances will be canceled.) Bankcard (Credit/Debit) First Name: Card Number: Expiration: Electronic Debit (ACH) First Name: Accnt Number: Last Name: Routing Number: Last Name: CVV : ZIP/Postal Code:

I voluntarily authorize a single non-refundable charge to my credit/debit card, or the initiation of a single non-refundable debit entry to my bank account in the above amount. If my check or bankcard payment is returned or declined, I agree to pay an NSF fee of $20, plus the cost of any bank fees associated with returned items.

Signature

Date
Email to: support@wakeupnow.com Fax: 801.769.3723

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