Fax Order Form

This form can be used to fax, mail or email in an order.

Fax to 727-441-4755   Attn: Andrew
Alt Fax to 727-451-1010   Attn: Andrew
Email to Andrew@BodyHealth.com
Or mail to: Andrew c/o BodyHealth.com Inc., 301 Turner Street, Clearwater, Florida 33756

Product info

Product name: ______________   Product name: ___________   Product name: _____________

Qty you want sent __________                   Qty: __________                    Qty: __________

Member info

Shipping Address:___________________________________________________

Shipping Address 2:_________________________________________________

City  ______________________________________ State  ________________

Zip _______________   Residential Address:   Yes_____ No ______ (Please check one)

Phone: (___) ___________________       E-mail:_________________________

Payment info

Visa _______ MasterCard _________ Amex ________ (Please check one)

Card #: _________________________________ Exp: ___ / ___ ( month/year)

CID** _____________ (THIS ORDER MUST INCUDE THIS)

Shipping info

Please circle one

USA Orders -                 UPS Ground   or    3-Day Select   or   2nd Day or   Next Day

International Orders -  International   or  International with Tracking

*To email this form either copy into a Word document or use the File/Send/Page by E-mail feature in your browser.

**The CID (card identification) number is the last 3 digits in the signature block on the back of your credit card. On American Express cards, it's the 4-digit, non-embossed number on the front of the card above your credit card number.