Registration Form for Mitzie's Kitchen Products of the Month Clubs

Name _____________________________________________________

Mailing Address______________________________________________

City______________________________________State_____________Zip_____________

Email______________________________________________________

Birthday______________

Note: Each program offers a different price point. You can choose either 3, 6 or 12 months of service. You are locked in for those times. If you want more months we can add that to your form. 

You have the choice of paying per month or all at once for the service and products.

By filling out this form you are committing to the period of time and amount you wish to spend for that specific order. You are authorizing Mitzie's Kitchen to bill your credit cards for the terms you agreed to.

_____ Hot Sauce of the Month Club            2 Hot Sauces per month

_____ 3 months ($29.95 or $89.85)   ______ 6 months ($29.95 or $179.90)

______12 months ($29.95 or $359.80)

______ Choose monthly payment ______ or in full payment________

Basalmic Vinegar/Olive Oil of the Month Club      2 Bottles per Month

_____ 3 months ($59.95 or $179.85)   ______ 6 months ($59.95 or $359.70)

______12 months $59.95 or $719.40)

______ Choose monthly payment ______ or in full payment________

 

_____ Decadent Fudge of the Month Club     2 One Half Pounds per month

_____ 3 months ($19.95 or $59.85)   ______ 6 months ($19.95 or $119.70)

______12 months $19.95 or $239.40)

______ Choose monthly payment ______ or in full payment________

 

_____ Phenomenal Products of the Month Club    A  Boxload of                   Goodies  per month

           Two Options: $59.95 box or a $99.95 box

Register here for $59.95 Medium Box Club

_____ 3 months ($59.95 or $179.85)   ______ 6 months ($59.95 or $359.70)

______12 months $59.95 or $719.40)

______ Choose monthly payment ______ or in full payment________

Register here for the $99.95 Large Box Club 

_____ 3 months ($99.95 or $299.85)   ______ 6 months ($99.95 or $599.70)

_____12 months $99.95 or $1199.40)

______ Choose monthly payment ______ or in full payment________

 

I authorize Mitzie's Kitchen to bill my card one time each month for the orders above.

Name on Card__________________________________________________

Card number ___________________________________________________

Exp Date____________________________ Security Code_______________

Billing Zip Code_________________________________________________