Order Form

Now that you are ready to make your award selection, please complete this form and send to Janssen Program Headquarters using the submit button below.

If you elect a Travel or Experiential Package, a travel concierge member will contact you to make your reservations.

Note: Any Team Award recipient that does not complete the award selection form after 60 days will be automatically awarded the 2,800 exclusively yours® points.

	*required fields
	*Recipient Name:
	Delivery Address: (No PO boxes allowed)*
	*City:
	*State:	*ZIP Code:
	Phone: (including area code)*
	*Email Address:
	We will confirm receipt of your order request within 2 business days. (if prompted, please allow this form to send an email) Items are subject to availability. Discontinued items will be replaced with items of equivalent value. You will be contacted for another awards selection if an appropriate substitution is unavailable.

	6322	LG 3D Package
	6334	Whirlpool Duet
	6346	Health & Fitness Select Fitness Watch: men's women's
	6358	Outdoor Recreation Select Color: black, red, light blue, tangerine, pink, seafoam green.
	6361	Game Room Select Wood: classic oak traditional mahogany Select Cloth: spruce, wine, navy, burgundy, dark green
	6373	Personal Accessories
	6385	Outdoor Sports Select Hand: right left Irons: Choose your shaft: regular stiff Driver: Choose your shaft: regular stiff Choose your Loft Degree: 10 1/2 LOFT 9 LOFT
	6401	Home Improvement
	6414	Outdoor Living Select grill energy: Natural Gas Liquid Petroleum
	8050	2,800 Award Points
	2020	Build Your Own Travel Award
	2021	Sonoma Golf, Spa and Wine Tour
	2022	New York City Trip
	2023	Las Vegas Trip
	2024	Napa Valley Trip
	3021	An Emmy Celebration Excursion
	3022	The Country Music Award Ceremony Experience
	3023	Excellence in Sports Performance Yearly Award Ceremony
	3024	California Wine Tour Experience
	3025	Excursion for Two to sports or Entertainment Venues