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MAIL / FAX ORDER FORM

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

FREE AROBAT READER:

ITEM

ITEM DESCRIPTION

COLOR / SIZE

UNIT PRICE

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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   Backstore.com, Inc. 13820 Stowe Dr Poway, CA 92064  https://www.vitalityweb.com 

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