T.J.CLARK MINERALS - BUYERS CLUB ORDER FORM
for "The TJClark Buyers Club" MEMBER Discount PRICES!
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Your Name__________________________________________________________ 
Address________________________________________ (business/residence) 
City_______________________________________________________________ 
State___________________________  Postal Zip_______ Country________
Home Phone______________________  Business Phone___________________
e-mail address:____________________________________________________ 
Shipping Address (no P.O.Boxes allowed if ship total is over $4.00)
Address________________________________________ (business/residence) 
City_______________________________________________________________ 
State___________________________  Postal Zip_______ Country________
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Sign me up to "The TJClark Direct Buyers Club"($15 membership fee)
Membership entitles you to buyers club prices listed below...
To maintain membership you agree to allow us to send at least
1 - CONCENTRATED Minerals Liquid 4oz @ $15.00 + S&H every month.
You can Change your Order, or Cancel Membership, at any time*
I also want the following delivered every month :
____CONCENTRATED Minerals Liquid 4oz.......$15.00 each..$___________
____ORIGINAL Minerals Liquid 32oz..........$17.50 each..$___________
____ORIGINAL Minerals 60 capsules..........$17.50 each..$___________
____CHROMIUM Picolinate Liquid 16oz........$17.50 each..$___________
____MSM Advanced Formula Liquid 32oz.......$12.00 each..$___________
____Multi-Vitamins 30 capsules.............$11.00 each..$___________
____Calcium/Magnesium 60 capsules..........$11.00 each..$___________
____Glucosamine/Condroitin 60 capsules.....$15.00 each..$___________
____Buyers Club Membership Fee  (for NEW Club Members)..$____15.00__
                                        My Sub-Total is $___________
             if delivered in Calif. add 7.75% sales tax  $__________
              refer to chart below to add Shipping Costs $__________
In freezing weather areas add "Signature Required" $2.75 $__________
                                            My TOTAL is $___________
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U.S. Shipping & Handling* - qty.->1      2     3      4     
All -   4oz. Liquid Product    $5.00  $5.00  $8.00  $8.00
All -   8oz. Liquid Product    $5.00  $8.00  $8.50  $9.50
All -  16oz. Liquid Product    $9.00  $9.50 $10.00 $10.50
All -  32oz. Liquid Product   $11.00 $12.00 $13.50 $14.00
All -  30-90 count Capsules    $5.00  $5.00  $5.00  $8.50
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Payment can be credit card, check, or money order (no cash please)
(note: credit card orders can only be sent to cardholder's address)

Visa/M/C/Amex Card #_________________________Exp. Date_________

Signature______________________________________________________ 
		Yes, I hereby authorize this charge

*If you cancel membership you can renew at any time for $5.00

MAIL or FAX to: Rodrigue & Sons Co. - Int'l Distributor
116 E. College Ave. Suite 170  Lompoc, CA 93436-5335 USA. 
Toll Free 24 hr. Order Desk: 800 913-4-TJC (800-913-4852)
FAX to: 1 805 737-9846 or Voice: 1 805 735-7103 between 9AM-5PM PST