Knf Purchase And Gift Form

The Know Now Foundation “Direct Purchase & Gift” Form Pre-registration as a KNF Ambassador Required The Know Now Foundation “Direct Purchase & Gift” program is purposed for providing registered Know Now Foundation Ambassadors (KNFA) direct access to Breast Chek Kits at the KNF direct price of $30 USD each. Purchases may be gifted directly to KNF or shipped to the purchaser for gifting or fundraising. Purchases may be made on a one-time, monthly, or, as needed basis. The Know Now Foundation accepts gifts of Breast Chek Kits only. 100% of all BCKs gifted directly to “The Know Now Foundation” are delivered to nonprofit and charitable organizations where they are gifted to women at risk. To make your contribution even more meaningful, KNF will include a “50% Matching Gift” on purchases gifted directly to KNF. For example, your gift of 10 Breast Chek Kits will create a total gift of 15 BCKs! Please note the matching gift program applies ONLY to direct gifts to KNF and not to purchases shipped for gifting or fundraising. For monthly purchasers, the transaction will be executed every month on or about the date of signature. Payment for one-time donations will be executed upon receipt. To participate please complete, sign, and fax this form to: +1-480-998-3582 (International) / 1-877-281-8322 (USA) KNFA & Purchase Information __ Please accept my purchase as a direct gift to KNF and include the KNF 50% Matching Gift __ Please ship my purchase to the address below (Shipping charges will apply) __ Monthly Gift (This transaction WILL be automatically executed on a monthly basis) __ 1-Time Gift (This transaction will NOT be automatically executed on a monthly basis) _____________________________________________________________________________ Your Registered KNFA Identity _____________________________________________________________________________ Shipping Address Number & Street City State/Province Zip/Postal Code __ 4 Breast Chek Kits __ 8 Breast Chek Kits __ 12 Breast Chek Kits __ 20 Breast Chek Kits __ 20+ Breast Chek Kits

$120 USD + shipping if not a direct gift to KNF $240 USD + shipping if not a direct gift to KNF $360 USD + shipping if not a direct gift to KNF $600 USD + shipping if not a direct gift to KNF Please call customer service: 480-998-3490, Ext 3

Credit Card Type qVisa qMasterCard qDiscover qAmerican Express Credit Card Number _________________________________________________ Exp ____/____/____ CVV Code: _______ (3 or 4 Digit Code on Credit Card) __________________________________________________________ ____/____/____ Authorized 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 payable to Plexus Worldwide, Inc.) Plexus Worldwide, Inc., 7025 E. Greenway Parkway, Suite 250, Scottsdale, AZ, 85254