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MAIL TO: Health-O-Rama
6619 Fulton Ave, Burnaby, BC Canada V5E 3G9
PAYABLE TO: Health-O-Rama Society
Credit Cards: Approved by PayPal and Internet Secure
ORDER DATE:_______________
Printable Orderform |
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Superlearning.com
Questions.
info@Superlearning.com
604-600-7513
604-736-5287
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Billing Information
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Shipping Address (if different)
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Name
____________________________________________
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Name
_____________________________________________
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Address
____________________________________________
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Address
_____________________________________________
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City
State/Prov
Zip/PC
____________________________________________ |
City
State/Prov
Zip/PC
_____________________________________________
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Country
Tel
_____________________________________________
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Country
Tel
_____________________________________________
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Email
_____________________________________________
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Email
_____________________________________________
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| Item Number
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Product Name
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Price
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Qty
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Total
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Sub-Total:
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| Ship/Hand:
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| HST Canada:
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| Grand Total:
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Shipping & Handling Fee
| Order Total |
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U.S.A. |
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Order Total |
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Canada |
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Order Total |
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International*
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| to $15.00
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+ $6.95
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to $15.00
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+ $6.95
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to $15.00
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+ $8.95+ $3/item
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| to $35.00
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+ $7.95
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to $35.00
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+ $7.95
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to $35.00
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+ $9.95+ $3/item
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| to $60.00
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+ $8.95
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to $60.00
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+ $8.95
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to $60.00 |
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+ $10.95+ $3/item
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| to $85.00
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+ $11.95
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to $85.00
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+ $11.95
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to $85.00
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+ $12.95+ $3/item
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| to $125.00
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+ $13.95
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to $125.00
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+ $13.95
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to $125.00
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+ $14.95+ $3/item
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| to $200.00
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+ $25.95
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to $200.00
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+ $25.95
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to $200.00
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+ $25.95+ $3/item
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*
International shipping available to major countries including: the UK,
Europe, New Zealand (except natural products), Australia, Asia. International rates are subject
to price adjustment; if necessary we will contact you.
| Check Method of Payment: ___ Check ___ International money order ___ American Express ___ VISA ___ Mastercard ___ Discover ___ PayPal Invoice(jack@jackcrisp.com)
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Card # _____________________________________________________
Expire Date ___________________________________
Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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Card Verification Number _________
(The last 3 digits on the signature panel on the back of MC or VISA; 4 digits on front of AMEX.)
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