“BOUNCE BACK” THE FITNESS CHAIR™
2189
West 390 North s
PRINT DOCUMENT BELOW
THEN MAIL, PHONE OR FAX TO ORDER!
EMAIL:
doug@allfit.com PROVIDE INFORMATION BELOW ON OUR SECURE EMAIL
ADDRESS
CUSTOMER/REPRESENTATIVE
RECEIPT/ORDER FORM
Date _____________________________________
Customer
Information: ______________________________________________E-mail___________________
Phone Res. (____)_____________________ Bus.
(____)_______________ Fax (____)_________________
Shipping Information:
Name _____________________________________________________
Phone (____) __________________
(WRITE SAME IF SHIPPING TO
ABOVE ADDRESS)
Address
______________________________________City
(NO P.O. BOX)
Representative Information: Call Doug at 888-272-2225 for a
Representative Near You!
OR CALL THE PERSON
WHO SHOWED YOU THE CHAIR.
Name _______________________________________E-mail_______________ Fax # (____)_______________
Product Information:
The frame color on all
chairs is Black Hammertone (charcoal) the seats are black vinyl.
Quantity __ “Bounce
Back” The Fitness Chair @ $_____. Inc. S&H $____________
(Comes with Regular Weight Springs 100-250#)
Heavy Weight Springs
(200-350#) $50 per set* $____________
Extra Heavy Weight
Springs (300-450#) $75 p/set* $____________
Rep. Pkt. ($50 also S.S.
# is needed) $____________
Other
Accessories _________________________ $____________
Sales Tax (6.25% - UT
Residence) $____________
TOTAL $____________
*Additional only at time of original shipment
in lieu of regular weight springs.
Method of Payment:
_____ Check
_____ Cash _____ Visa - M/C _____ Am/Exp
_____ Discover
CREDIT CARD # ________ / ________
/ ________ / ________ EXP. DATE ____/____
Verification Number (The three numbers on
back of Credit Card) #__ __ __
CUSTOMER SIGNATURE____________________________________________________
(SIGNATURE REQUIRED - ABOVE INDIVIDUAL AGREES TO PAY AS ABOVE
STIPULATED)