Allfit® Enterprise Sales

DIVISION OF:

2189 West 390 North s Provo UT 84601

Phone (801) 344-8520 s (888) 272-2225 s Fax (801) 377-4821

Email doug@allfit.com

CUSTOMER RECEIPT/ORDER FORM

Date ___________________

Customer Information:

Name_______________________________________________________________________

Phone (Res.) (____)____________ (Email)________________ (Fax) (____)_____________

Address ______________________________City _____________ State ____ Zip ________

ALL ORDERS MAY BE PHONED, FAXED OR MAILED (Make copy) TO ALLFIT ENTERPRISE OR EMAIL INFORMATION TO doug@allfit.com

Item Number Price Total

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Subtotal $_______

Sales Tax (6.25% -UT Residence) $_______

Shipping & Handling $_______

Total $________

Method of Payment:

____ Check ____Cash ___ Visa ___ M/C _____ AmExp ____ Discover

CREDIT CARD # ___________/____________/____________/____________ EXP. DATE _____/_____

CUSTOMER SIGNATURE _______________________________________________________________________

(SIGNATURE REQUIRED - IF ORDER TAKEN BY PHONE REP. SIGNATURE REQUIRED, AGREE TO PAY AS ABOVE STIPULATED)

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