Fax Order Form

Fax Order Form

	To place a fax order, complete the form below
	Print this form using FILE/PRINT on your web browser or simply press the PRINT icon
	Fax this form to 1-210-497-3854

Thank you,
HealthWorks 2000

Please complete the information below. Note, all customer information is required to process your order.

Name

Email Address

Street Address

Apt#:

City

State: Zip:

Country

Phone #

Product(s)

Qty.	Product No/Description	Price












Subtotal:
Shipping & Handling $3.95 or FREE with order of $50.00 or more)*:
Order Total:
Pay by Credit Card (Visa, MasterCard, Discover) Credit Card & CCID# Exp mm/yy:

Terms & Conditions:

	Quantity and product specified will be processed and shipped with in 24 hours.
	Price of the products will the current price as reflected on www.healthworks2000.com at time of order.
	Price is subject to change
	See shopping guide for shipping and handling

* SHIPPING IS FREE for all the continental US and Canada order of $50.00 or more.
Otherwise, shipping is only $5.95. If you're outside the continental US or Canada, please email international@healthworks2000.com for current shipping rates.

[Guide to Shopping]