GoJane.com Mail-In Order Form

Print out this order form, complete it and mail to the address below.

Name: ____________________________

Address: __________________________

City: _____________________________

State: _______ Zip Code: ___________

Email: ________________________________

Phone # (______)____________________

Birth Date____/____/_____

PLEASE PRINT LEGIBLY. Money Orders only. No cash or personal checks.

Please contact us with the Money Order serial number so we can place your items on hold.

Send this form with the correct amount of money to:
GoJane.com Orders
2900 East Spruce St.
Ontario, CA 91761

Item #	Item Name	Color	Size	Price	Quantity	Total
				$		$
				$		$
				$		$
				$		$
				$		$
				$		$
				$		$
CA only - add 7.5% sales tax						$
Shipping Please see shipping charts here.						$
				Grand Total		$