ORDERED BY:
Name:________________________________________
Street Address:_________________________________
TO ORDER-
MAIL THIS COMPLETED FORM TO:
SUNSHINE NATURAL HEALTH INC.
5987 SE RIVERBOAT DR. #636
STUART, FL, 34997
PHONE: Please supply daytime telephone (____) ____ - _____. This will only be used if we
have a question reagrding your order. For fax orders, supply fax number if you would like
order confirmation faxed to you. (____)____-_____ .
CHECK or MONEY ORDER Amount enclosed ______$95.95
Payable to: Sunshine Natural Health Inc.
CREDIT CARD PAYMENT
MasterCard ___
Visa ___
American Express ___
Card Account Number:_____________________________ Experation Date:_______
Signature:_______________________________
Charge $95.95
| YOUR BILLING ADDRESS Name:_________________________ Street:_________________________ Address:_______________________ City:___________________________ State:__________________________ Zip:____________ Phone:(____)____-______ |
YOUR SHIPPING ADDRESS Name:_________________________ Street:_________________________ Address:_______________________ City:___________________________ State:__________________________ Zip:____________ Phone:(____)____-______ |
FREE SHIPPING AND HANDLEING ON ALL ORDERS
THANK YOU FOR YOUR ORDER!
© 2005 SUNSHINE NATURAL HEALTH INC.