Name ____________________________________________
Address __________________________________________
City/State/Zip _____________________________________
Telephone __________________________
Please provide your telephone number if paying with a credit card.
E-mail _____________________________
Include your e-mail address if you wish to receive order confirmation.
Please enter your date of birth ___________ (dd/mm/yy)
Please confirm that you are at least 18 years of age.
____ Yes, I certify that both myself and the recipient of this product
are at least 18 years of age.
____ No, I am not 18 years of age.
PAYMENT OPTIONS:
___ Credit Card (Circle one) Visa Mastercard AMEX Discover
Card # _______________________________ Exp Date______________
Name on Account____________________________________________
Signature____________________________________________________
____ Cashiers Check ____ Money Order ____ Check* (Please allow 5-6 business days for check to clear)
All funds must be paid in U.S. dollars.
* There will be a $25.00 fee assessed for returned checks.
QUANTITY:
______ Metabolife Ultra Bottle(s) - [$29.95 each]
PLEASE CHECK APPROPRIATE SHIPPING METHOD
______ US Mail - $2.00
______ US Priority Mail - $4.25
TOTAL ORDER $__________
Make Checks Payable to: The AllCo Group
Mail to the address below, or fax credit card orders to (561) 258-0698.
The AllCo Group
728 Cape Cod Circle
Valrico, FL 33594
