“BOUNCE BACK” THE FITNESS CHAIR™

2189 West 390 North  s  Provo UT  84601  s Phone (888) 272-2225  s Fax (801) 377-4821

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 (____)_________________

 

Address ______________________________________ City _________________ State ____ Zip _________

 

 

Shipping Information:

 

 Name _____________________________________________________ Phone (____) __________________

                                    (WRITE SAME IF SHIPPING TO ABOVE ADDRESS)

 

Address ______________________________________City __________________ State ____ Zip _________

                                                                           (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 # (____)_______________

 

Address ________________________________________ City ________________ State ____ Zip __________

 

 

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 instead 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)