Roll Away The Pain ™ Order Form

by www.SavvyRx.com

Mail/Fax/Email your order to:
         

LifeStar LLC
PO Box 3645
Tequesta FL 33469

  

Fax: (561) 658-8425
Email: rollaway@SavvyRx.com
http://www.SavvyRx .com

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ORDERED BY (Billing Information):

ALTERNATE SHIPPING ADDRESS
(if different than name and address at left)
Name:
  Name:
Address:  
  Address:
City:  
State: Zip: City:
Telephone: (            ) State: Zip:
Email Address:    
       

QTY.

ITEM #

DESCRIPTION

PRICE

TOTAL
   662  Roll Away The Pain ™  $14.95  
         
         
         

Add totals from this page and any additional pages..............SUBTOTAL
Florida residents - 6%..............SALES TAX
SHIPPING
Add subtotal, sales tax, and shipping.......ORDER TOTAL

  
 

FREE
 

Shipping:  Your order will be sent from our warehouse in South Florida. Please visit our site's Shipping page to find out about Transit times and rates.
 

Payment Information- if you would like an email receipt emailed to you, please remember to include your email address above.

 
  Payment Method: (circle one)                              (Make Check/Money Order out to LifeStar LLC)
Visa   M/C   Amex    Check    M/O

Card #: _____________________________
Exp. Date: _______________
Name-As on Card: ____________________
Signature ___________________________

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