EmailMe Form - Meal Plan Sign-Up

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code

Phone *

### - ### - ####

Email *

Please make sure you type in proper e-mail. Your confirmation, important information and code for the option of "creating your own" go to the address you input.

Select Your Meal Plan *

Allergies? Dislikes? Comments? Please Specify.

We can only accommodate certain substitutions.
We will contact you if we see something we cannot accommodate.

Pick Up or Delivery *

Pick Up - 3047 Hedley Springfield

Pick Up - 2329 Plum St Edwardsville

Delivery ($15 weekly) for orders within a 40 mile radius of Springfield, il (Some exclusions may apply)

Delivery ($15 weekly) for orders within a 40 mile radius of Edwardsville, il (Some exclusions may apply)

Start Day *

Tuesday

Friday

(Pick Up/Deliveries are on Tuesday and Friday)

Preferred Start Date *

MM / DD / YYYY

Choose a Tuesday or Friday at a future date

Promo Code:

Billing Details

Enter your debit/credit card for weekly payments.

Name on Card *

Credit Card *

My billing address is the same as my shipping address

Yes

No

Billing Address *

Street Address City State / Province / Region Postal / Zip Code

I authorize Just Right Eating to charge my card for the meal service selected above: *

Yes, I authorize.

I understand this program requires a minimum 4 week commitment. After that I may cancel at anytime. My card will be charged weekly until I fill out the suspension/cancellation form to cancel service. *

Yes, I understand.

I understand that if I need to suspend/cancel/change meal plan service I will provide notification via "suspension/cancellation/change meal plan form",which is on our website under "forms and info", by noon (12 p.m.) the Friday before I need suspension of service/cancellation to avoid further charges. *

Yes, I understand.

I understand that my insulated bag must be returned at next delivery or pick up. Disposable bags do not need to be returned. *

Yes, I understand.