Jitterbug Order Form

Have a question about placing your order? Call us at 877-744-8780.

One Step Checkout

Customer Information     Please enter your address as it appears on your credit card or bank statement.
Full Name: Address 1: Address 2 (Optional): City: State: Zip: Email Address: Contact Phone:	Please use your full legal name. A daytime contact phone number is required in order to process your application. This number will not be called unless additional information is required to approve your order.

Who will use this Jitterbug phone

This phone will be for me

This phone will be a gift

If this is a gift, please enter the recipients name below.

First Name: Last Name: Address 1: Address 2 (Optional): City: State: Zip Code:

Please tell us where you want the phone shipped

Ship the phone to me

Ship the phone to the person who will use it

Select your Jitterbug phone
Jitterbug Dial - $147	Jitterbug OneTouch - $147

Select your service plan

No long term contracts. No long distance or roaming fees. Add on Minutes don't expire for up to a year!

Service Plan Monthly Rate Anywhere, Anytime Minutes a Month SOS $10 Pay as you go at $.35 a minute Simple 30 $15 30 Simple 60 $20 60 Simple 150 $30 150 Simple 300 $40 300 Simple PLUS - Monthly $80 800 Jitterbug for a Year Annual Rate Anywhere, Anytime Minutes 12 months of service     and FREE voicemail $120 Pay as you go at $.35 a minute OR Add on Minutes below

Would you like to add extra minutes?

Add on Minutes are good for 12 months from the date you purchase them.

Anywhere, Anytime Minutes Cost Rate Per Minute None                                                   100 $25 $0.25 500 $100 $0.20 1000 $150 $0.15

Would you like to add voicemail service?

($3.00 per month or FREE with Simple PLUS - Monthly or Jitterbug-For-A-Year)

Yes

No

Would you like to add any of these Jitterbug accessories?

Emergency Battery Charger - $6

Black Leather Case (Vertical) - $19

Black Leather Case (Horizontal) - $19

Car Charger - $24

Car Charger and Black Leather Case - $39

Jitterbug Battery - $39

AC Charger - $19

Hands Free Car Kit - $49

Beaded Lanyard - $12

Add phone numbers you'll call most often

These 10-digit phone numbers will be pre-loaded into your phone before it ships, so your Jitterbug is ready to use when it arrives.

Name: Number: Name: Number: Name: Number: Name: Number: Name: Number:

Payment Information

Credit Card Number: Expiration Date: Card Verification #: