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Billing Address (must match credit card billing address) First Name: ______________________ Initial: __ Last Name:________________________________ Address:__________________________________ City: _________________ State: ___ Zip: ______ Phone: ________________ Fax: ______________ Email Address: ____________________________ |
Shipping
Address (If different
from Billing Address) First Name: ________________________ Initial: __ Last Name:__________________________________ Address:_____________________________________ City: ___________________ State: ____ Zip: ______ Phone: ________________ Fax: _________________
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Payment Information (please circle one): Visa MasterCard American Express Discover MoneyOrder2 Check2 Credit Card#: _______________________ Security Code: ______ Expiration Date: ____/______ Signature:__________________________________ |
| Product Code3 | Price | Product Code3 | Price | |
If you ordered the KAMM-12, we need the following information to complete your report:
Your Birth Date: ___/___/______ Age: ____ Sex: ____ Height: ___ft ___in Weight: _____ lbs.
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Note: Use Shipping Charges As Follows: Vitamins / Supplements <1 lb -- Priority 2day Shipping ($14.75) Vitamins / Supplements >1 lb -- Priority 2day Base Shipping ($16.00) Metabolic Reports - Standard Shipping Free Metabolic Reports - Priority Shipping ($24.00) Books and Publications Base Rate --($7.50)
Gifts/Glassware -
(Call Us, Final Determined when Shipped)
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Product Total: ______.___
Tax: (CA only, 8.5%)
______.___
Shipping: ______.___ TOTAL: ______.___ |
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1Orders
placed by Fax or Phone are considered web site use and by ordering, you
agree our online Terms of Use Agreement (http://egetbetter.com/docs/terms_of_use.htm.)
A Better Health Nutrition and Vitamin Store (egetbetter.com) 1941 Gladstone Way Salinas, CA 93906 3Product Codes can be found at http://egetbetter.com/docs/listOfProducts.htm |