Knf Ambassador Form

7025 E. Greenway Parkway #250 Scottsdale, AZ 85254 USA: 1-877-281-8333 FAX: 1-877-281-8322 Non USA: +1-480-998-3490 FAX: +1-480-998-3582 Customer Service: 1-480-998-3490, Ext 3 Customer Service Email: [email protected]

Know Now Foundation Ambassador Registration Form Please complete, sign and fax to the applicable fax number above. _____________________________________________ Your Name or Name of Organization / Company

____________________________ Primary Phone Number

_____________________________________________________________________________ If Joining by Name of Organization / Company, Contact Person’s Name, Phone & Email ______________________________ Alternate Phone Number

____________________________________________ Primary Email Address

_____________________________________________________________________________ Street Address City State/Province Zip/Postal Code ______________________________________________________ Your Sponsors Name

___________________ Sponsor’s Plexus ID#

________________________________________________ New KNFA’s Signature

____/____/____ Date of Signature

Purpose of Gift q Please accept my purchase as a direct gift to KNF and include the KNF 50% Matching Gift q Please ship my purchase to the address above (Shipping charges will apply) q 1-Time Gift (This purchase will NOT be automatically executed on a monthly basis.) q Monthly Gift (This purchase WILL be automatically executed each month and can be shipped to the destination of your choice or gifted directly to KNF.) Amount of Breast Chek Kit Gift (Shipping is added to purchases NOT gifted to KNF) q Goodwill Ambassador 4 Breast Chek Kits / $120 USD If not gifting to KNF please add shipping: USA $12.95 / Canada $14.95 q Bronze Ambassador 8 Breast Chek Kits / $240 USD If not gifting to KNF please add shipping: USA $14.95 / Canada $16.95 / Other $19.95 q Silver Ambassador 12 Breast Chek Kits / $360 USD If not gifting to KNF please add shipping: USA $16.95 / Canada $19.95 / Other $24.95 q Gold Ambassador 20 Breast Chek Kits / $600 USD If not gifting to KNF please add shipping: USA $19.95 / Canada $24.95 / Other $29.95 q Platinum Ambassador 50 BCKs / Please call customer service: 480-998-3490, Ext 3 q Pink Ambassador 100+ BCKs / Please call customer service: 480-998-3490, Ext 3 Credit Card Type qVisa qMasterCard qDiscover qAmerican Express Credit Card Number ___________________________________________ Expiration Date ____/____/____ CVV Code: _______ (3 or 4 Digit Code Credit Card) __________________________________________________________ ____/____/____ Authorized Payment Signature Date of Signature THANK YOU for your generous gift and for moving the KNF mission forward! To pay by check, mail to: (Please make pyable to Plexus Worldwide, Inc.) Plexus Worldwide, Inc., 7025 E. Greenway Parkway, Suite 250, Scottsdale, AZ 85254You may want to retain a copy of this document for tax purposes.