Complete
all information, print form, then mail form
Shipping
To Information:
Name
*
Address
*
Address
2
City
*
State*
Zipcode*
Country
*
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.
Calculate
Total and Enclose Proper Amount
Product
Qty
Price
Total
Price
$
Standard
Shipping (3-8 business days) - $2.95
RUSH
Priority Shipping (2-3 business days) - $6.95
Overnight
Express (1 business days) - $19.95
(Certain locations may be 2 day via express)
Check
box for what will be enclosed
Money Order/Cashiers Check/Personal Check
Make
checks payable to : Exp Online
Mail Payments to:
InnerVital
PO Box 1177
Penfield, NY 14526
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.
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.
