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
950 N. Barrington Ave.
Ontario, CA 91764

Item # Item Name Color Size Price Quantity Total 
        $      $
        $    $
        $    $
        $    $
        $    $
        $    $
        $    $

 CA only - add 7.5% sales tax     


Shipping Please see shipping charts here.     


Grand Total      


Thanks for your order and have a great day!  We will notify you by email upon the arrival of
your order and payment.  An invoice will be included with your order.

GoJane.com is not responsible for stolen, damaged, or lost orders.  This also includes payments lost in the mail.