VITAMIN POWER HEALTH PRODUCTS.

William R. PAYNE[Authorized Distributor]

309 Sunset Dr. - High Point, NC 27262-3838

Phone: (336)886-2551 Fax: (336)886-7468

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Customer Order Form

Ship To:

Please Include Street Address, as we are not able to ship to P.O. boxes.

Address: 

Address2: 

City: State: Zip Code: 

E-Mail: 

Phone: Ext.: 

Fax: 

Additional Comments: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Product: Qty: Price Each: Total Price: 

Sub Total : 

Deduct Applicable Discount 

Add $4.00 For Shipping and Handling:

Total Price: 

Submitting Order

You can print out the above form and mail it along with payment to:

William R. Payne

309 Sunset Dr.

High Point, NC 27262-3838

If you can't print this form, you can write your order on a plain sheet of paper making sure you indicate complete shipping address, correct prices, correct product numbers and quantities, and bottle sizes.

"Thanks for your order."

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