** Required information -
If you do not fill this information completely, the contract is invalid.
As sole rights holder, 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:
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 $2-10 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.
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.
Phone Number ______________________________________________________________
Email Address: ________________________________________________________________
Subscribed and sworn before me,
this _________________ day of _________________________, 20__.
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.
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