MrVitaHerbs Mail Order Form

Item Number Product Description Qty Item Price Total Price
         
         
         
         
         
         
         
         
         
         
Sub-Total    
If orders are below $40 add $4.95 for Shipping/Handling   Shipping/Handling    
Taxes: for Ohio Residents only add 7%   Tax (for Ohio Only)    
Grand Total    
 
Shipping Address:   Name: ____________________________________________
 
                             Address: ____________________________________________
 
                City, State, & Zip: ____________________________________________
 
                   Phone Number: ____________________________________________
 
                                E-Mail: ____________________________________________
 
Billing Address:  (Only needed if different from shipping address)
 
                                  Name: ____________________________________________
 
                              Address: ____________________________________________
 
                City, State, & Zip: ____________________________________________
 
Payment Methods: (Personal checks not accepted)
Cashier or Certified Check: ____       Money Order: ____       Credit Card: ____
(Make Cashier, Certified check or Money Order payable to Alan Mowery dba MrVitaHerbs)
Credit Card:  Visa _____       MasterCard _____       AMEX _____       Discover _____
 
Credit Card Number: _____________________   Exp. Date: ________   Verification Code*: _____
* For your safety and security, MrVitaHerbs Merchant Services requires that you enter your card's verification number. The verification number is a 3-digit number printed on the back of your card. It appears after and to the right of your card number. If you have an AMEX card the verification number is a four-digit number on the front and to the right of your card.
 
Reminders:
After fully completing this form please mail to:
Alan Mowery dba MrVitaHerbs
1621 Cohasset Drive
Cincinnati, Ohio 45255
USA
Your information is secure!
To complete your order we need a valid email address and phone number.
If you are interested in a FREE MEMBERSHIP your order must be $40.00 or more (excluding taxes and shipping) then call Toll Free: 1-877-883-8313 to redeem free membership.
If you are interested in a part-time or full-time income call us at 1-877-883-8313 and we can show you how!!