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Printable Order Form

1002 Jupiter Park Lane
Jupiter, FL 33458
Ph: 800-835-0850
Mon-Fri 9 am to 6 pm EST, Closed Sat & Sun
1-800-835-0850
FAX: 561-575-7935
Referred by · Bodhi Idarius · Customer # 122928

Name______________________________________ Dist # _________ Date ___________

Address____________________________________ City __________ State ___ Zip _____

Phone _____________________ Email ____________________ If MAS Order_____(initial)



DESCRIPTION
LIQUID
VEGI CAPS
PREFERRED PRICE
TOTAL
         
         
         
         
         
         
         
         
         
         
         
         

 

Free Products ______________________
(Buy 5, get i of equal or lesser value FREE. or w/ Value Paks above)

    

SHIPPING & HANDLING
(UPS GROUND)

If dollar amount is
$0-$99=$5
$100-$299=$10
$300-$499=$15
Over $500=free

  
 Credit Card Orders

   #______________________Exp.___/____

   Sig________________________________

   Date _______________


__ American Express
__ Discover
__ MasterCard
__ Visa
__ Check
__ Money Order
__ Check by FAX

  Subtotal  
 Shipping  
 Less
 MAS Bucks		  
 TOTAL