MAIL ORDER FORM
| Simply Print & Mail Payment To: |
| FB Marketing |
| PO Box 2383 |
| Jamestown, NC 27282 |
| Make certified checks and money orders payable to FB MARKETING. All shipments are packaged DISCREETLY. Credit card orders will appear on your statement as FB MARKETING. NOTE: Personal checks are accepted, however, shipment will only be made after the check clears. This process usually takes 7-10 days... |
| CARD HOLDER INFORMATION | |
| Name | |
| Street Address | |
| City | |
| Country | |
| State | |
| Zip/Country Code | |
| Email Address | |
| Phone Number | |
| Fax Number | |
| DELIVERY INFORMATION (Leave blank if same as CARD HOLDER ADDRESS) |
ITEM CODE |
DESCRIPTION |
PRICE US$ |
QUANTITY (Specify) |
001 |
1 bottle, 1 month supply |
$ 39.95 |
|
002 |
2 bottle, 1 month supply |
$ 69.95 |
|
003 |
3 bottle, 1 month supply |
$ 99.95 |
|
004 |
4 bottle, 1 month supply |
$ 119.95 |
|
005 |
Each Additional bottle after 4 |
$25./each |
|
| SHIPPING INFORMATION | |
| SHIPPING IS FREE! | |
| CREDIT CARD INFORMATION | |
| Please circle the credit card type being used | |
| MASTERCARD AMEX VISA | |
| CARD NUMBER | |
| EXPIRATION DATE | |
| *SECURITY CODE | |
| *This is the three or four-digit security code that is printed on credit cards. The value appears in reverse italic at the top of the signature panel on the back of the credit card, or just above the end of the credit card number on the front of the card. | |
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