** Required information -
If you do not
fill this information completely, the contract is invalid.
I authorize Gregath Company, Incorporated
to advertise and sell:
**_____________________________________________________________________________________
Gregath Company, Incorporated will forward
the following
**(check one
and fill out
completely)
□
payment via check to:
Name:
_________________________________________________________________________
Address:
_______________________________________________________________________
City/State/Zip:
_________________________________________________________________
Please
include pre-addressed mailing label (choose one) - YES
NO
□
delivery mailing information and electronic payment via PayPal (email provided
below).
Forwarded payment is figured thusly:
Gregath's retail price, which I have
established at
**$_______________
less 20% which is **$_______________ (price per item I will
receive)
plus a shipping allowance which will be
from $2-6 dollars per item.
I agree to mail all orders by
**(check
one and
fill out)
□ Post
Office via _____________________________________________ (type/class)
□ Other
Carrier _____________________________________________
(specify)
to the designated customer within 10 days
of receipt of forwarded order.
_______________________________________________________________________________________
**Signature **Date
Phone
Number ______________________________________________________________
Email
Address: ________________________________________________________________
I further agree to notify
Gregath Company, Incorporated when my supply of items is sold down to ten (10) items and/or there is
any other change in the status of the item which may effect the ability of
filling these orders.
**Subscribed and sworn before me,
this _________________ day of
_________________________, 20__.
____________________________________________________________________
(If
Notary Public) My commission expires
Please provide a description of item for Advertisement
(optional):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Further
comments/PR for advertisement and future reference should be placed on reverse
or a separate sheet.
Thank you for your interest.
This Page Last Updated:
April 13, 2012
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