order_form

Order Form

Name:

___________________________

Shipping Address:
Address:	___________________________
City, State, ZIP	___________________________

Phone Number:	___________________________
E-mail Address:	___________________________
Billing Address: (If different from shipping address)
Name:	___________________________
Address:	___________________________
City, State, ZIP	___________________________

Stock Number	Description	Quantity	Unit Price	Total Price

Sub Total:
Add $10.95 for Ground Shipping/Handling:
Retail Sales Tax:
Total Price:

Payment Information:
___ Credit Card ___ Cashier or Certified Check ___ Money Order

Credit Card Information: ___Visa ___MC ___AMEX ___Discover

Credit Card Number:______________________________________________ Exp. Date: _______

Check here if you would like to become a preferred customer __________

Please mail this form to:
Neways USA
2089 West Neways Drive Springville, UT 84663

Please make any checks payable to Neways USA
If you need more space for your order please print more copies and attach and send together.
Orders over $2000 are shipped free.
If you have questions, email us at info@healthandsunshine.com
Cheri McCain - Neways Distributor