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MAIL / FAX ORDER FORM

Click HERE to get our MAIL/FAX ORDER FORM via Adobe Acrobat Reader!

FREE AROBAT READER:

SHIP TO: Please write clearly!!!

NAME: _________________________________________________________
 
 
ADDRESS: ______________________________________________________
 
 
CITY: __________________________ State: ________ ZIP: _________
 
 
PHONE: _________________________________
 
 
E-MAIL:(for order confirmation) ________________________________
 
The Credit Card Name must be the same as the "ship to" name for 
all credit card orders!!
  
PAYMENT METHOD:  Check_____   VISA_____   MASTERCARD_____  DISCOVER____
 
Account # _________________________________   Exp. Date _________________
 
Name on Credit Card ________________________________
 
Billing Address of CC (if Diff)______________________________________
 
Please make checks payable to VITALITYWEB.COM
Fax orders (888)280-0299 or (858)218-1321 - 24 hours/7days
Phone orders (888)293-0728 or (858)218-1320 - 9:00 - 5:00pm PST
 
VITALITYWEB.COM, Inc.
13820 Stowe Dr
Poway, CA 92064 
https://www.vitalityweb.com