Enroll me in ICS's Monthly AutoShip Program.
(If checked, fill out method of payment information below). I understand that I am ordering and ICS will automatically ship a one pound box of JULIETTE™ Chocolates each month to me for one year. Orders paid by Automatic checking Account withdrawals will be shipped one week after credit card orders are shipped.

I would like my Monthly AutoShip Program orders to be shipped to my shipping address.

I would like my Monthly AutoShip Program orders to be shipped to:

______________________________________________________________________ (other address).

Payment by Automatic checking Account withdrawal

(Must attach a voided check & an ACH Authorization Form)

Payment by Credit card

Card type: VISA MasterCard

Name (as it appears on card) ____________________________________________________

Credit card number __________________________________ Exp. date __________

Credit card billing address ______________________________________

Billing zip___________

Signature _______________________Date ____________________

I wish to discontinue my Monthly AutoShip at this time.

Signature _______________________Date ____________________

Monthly AutoShip changes need to be received by ICS by the 25th of the month for the change to take place the following month.