Vitamin-one.com

PREFERRED CUSTOMER ORDER FORM

Associate ID#: 296618

SHIPPING INFORMATION                                                                     Language Preference
First Name    Last Name   Email
       Street     City 
        State      Zip Code    County      USA
Day Phone   Evening Phone   Fax   

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 #   Expires (Month) (Year)

Card Holder's Name   Card Holder's Signature                                                      
Credit Card Statement Address (if different from shipping address):    Street
                                 City State: Zip Code   

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.

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

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