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Order Form |
Pricing: Orders for single tapes are $30 each. Discounts are available for multiple tape orders.
Product or Item Number (example C-201) Quantity Subtotal
______________________________________ __________ $________
______________________________________ __________ $________
______________________________________ __________ $________
______________________________________ __________ $________
______________________________________ __________ $________
______________________________________ __________ $________
______________________________________ __________ $________
Subtotal: $________
Colorado Residents must add 7.3% (subtotal X .073) for sales tax $________
Shipping charge for up to 10 tapes is $7. (Contact HealthIx if over 10 tapes) $________
Grand Total: $________
Bill To:
Full Name:__________________________________________________________________________
Company:___________________________________________________________________________
Address:____________________________________________________________________________
City:_______________________________ State: _____ Zip Code:_____________________________
Phone:_____________________________________________________________________________
Email:______________________________________________________________________________
Ship To: (Same as above _____)
Full Name:__________________________________________________________________________
Company:___________________________________________________________________________
Address:____________________________________________________________________________
City:_______________________________ State: _____ Zip Code:_____________________________
Phone:_____________________________________________________________________________
Payment: _____VISA _____MasterCard _____American Express
Name on Credit Card:_________________________________________________________________
Credit Card Number:__________________________________________________________________
Expiration Month:_____________________ Expiration Year:__________________________________
Send Orders via:
Phone: 1-800-470-0017 FAX: 1-800-757-4352 Web: www.healthIx.com
Mail: HealthIx P.O. Box 16759 Golden, CO 80402
Policies:
If you receive a defective or damaged product, return it and it will be exchanged, no questions asked.
Phone: 1-800-470-0017 • Fax: 1-800-757-4352 • Mail: P.O. Box 16759 Golden, CO 80401