280 Newspaper Information Order Form

Just print this form out and mail it to us at:

JennTech, Inc.

PO Box 533, Exeter, RI 02822

Or Credit Card Orders FAX To 401-294-7981

Name_______________________________________________________

Street_____________________________________________________

City_______________________________________________________

State__________________ Zip_____________________

Method of Payment: Please send $19.95

Cash___________ Check__________ Money Order_____________

Visa__________ Master Card__________

Account Number____________________________________

Exp. Date___________________

Signature __________________________________________
Note: Name and address on card MUST be the same as buyer name above.

Optional Information:
Email address_______________________________________________________

How did you hear about us?
__________________________________________________________________
Thank you for your purchase. Your order will be sent to you FIRST CLASS MAIL at no extra charge. Please make checks payable to: JennTech, Inc.

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Email us at: Admin@jenntech.com