Mail In Order Form

You may print this form and mail us a check or money order to purchase our products. Personal checks may take 2 weeks to clear. Cashier's check or a money order is recommended. If you do not have a printer, just send all required info on a blank piece of paper. Make checks payable to EXP online. Mail to address below
If you are not a US resident we can only take bank checks in USD funds.

Complete all information, print form, then mail form

Shipping To Information:

	Check if you are a repeat customer
Name	*
Company
Address	*
Apt. or Suite
City	*
State/Province	*
Zip Code	*
Country

Phone Number
Email Address *	*

All fields marked with an '*' are required.

Choose Product

Please list the product you would like to order, the quantity you would like and the price.

Product	Qty	Price

Standard Shipping (3-8 business days) - $3.95
(If your order is over $50 Standard shipping is FREE)

RUSH Priority Shipping (2-3 business days) - $7.95

Overnight Express (1 business days) - $19.95
(Certain locations may be 2 day via express)

Calculate Total and Enclose Proper Amount

Check box for what will be enclosed

Money Order/Cashiers Check/Personal Check
Make checks payable to : Exp Online

Mail Payments to:
InnerVital
54 Winchester Drive
Fairport, New York 14450

Pay with credit card :
PLEASE NOTE : The address above must match the address on file with your credit card company.

Circle one : MC/VISA/DISCOVER/AMEX
Card # : __________________________
Exp Date : __/__/____
mm/dd/yyyy
CSC Code : ______
This code will be 3 or 4 digits. On AMEX it is a 4 digit code on the front of the card and on all others is the 3 digit number on the back of the card where the signature is.