Vitamin-one.com

PREFERRED CUSTOMER ORDER FORM

Associate ID#: 296618

CONTACT  INFORMATION
( * indicates required fields )

First Name*      Last Name*      
Day Phone*     Evening Phone*        Fax Number    
Language Preference*    E-mail*    

Main Address (billing address):*
The billing address must match the address on your credit card statement.

Street*     City*   
State*      Zip Code*      County*   USA

Shipping Address (if different from main address)

Street       City      
State         Zip Code        County    USA

Item# - Description [Autoship Price] Qty
   
 
 
 
 
 
 

**1 Specify flavor choices for item 250 above:
       

Sales Tax will be added where applicable. Shipping/Handling* cost will be based on weight.

Payment Method         Card Number     ---
Card Holder's Name         Expires (Month)     (Year)    

SAVE an additional 10% by enrolling in AUTOSHIP. Monthly supplies will be delivered automatically. You can customize or cancel your shipments at any time.     enroll me in AUTOSHIP to save an additional 10%.

* SHIPPING AND HANDLING
Your shipping cost will be actual freight cost plus a USD $1.00 handling fee. Your shipping charge will be an estimate made at the time of your order. The estimate is a computer generated charge and is calculated using the weight of the product and the fill material.

Enter Comments, Questions or Additional Information below: 

                                                                    

Optional ways to order: FAX this order to: 1-800-289-8081
                                      or MAIL to:  Vitamin-one.com    BOX 98     Lomita, CA  90717
                                      or CALL Order Express: 1-888-950-9595

TO PRINT THIS FORM:  Right click on your mouse and select PRINT.