“BOUNCE BACK” THE FITNESS CHAIR

2189 West 390 North  s  Provo UT  84601  s Phone (888) 272-2225

PRINT DOCUMENT BELOW THEN MAIL, PHONE OR EMAIL!

EMAIL:  doug@allfit.com  PROVIDE INFORMATION BELOW ON OUR SECURE EMAIL ADDRESS

CUSTOMER/REPRESENTATIVE RECEIPT/ORDER FORM

 

Date _____________________________________

 

 

Customer Information: ________________________________________________________________________________

 

Phone   Res. (____)_____________Bus Phone (___)____________ Email _______________________________________

 

Address _________________________________________ City _______________________ State ______ Zip _________

 

 

Shipping Information:

 

 Name _____________________________________________________________ Phone (____) ___________________

                                    (WRITE SAME IF SHIPPING TO ABOVE ADDRESS)

 

Address _________________________________________City ______________________ State _______ Zip _________

                                                                           (NO P.O. BOX)

 

Representative Information:     Call Doug at 888-272-2225 @ ALLFIT ENTERPRISES LLC

                                                OR CALL THE PERSON WHO INTRODUCED YOU TO THE FITNESS CHAIR.

                                               

Name _______________________________ Phone _________________E-mail__________________________________

 

Address ________________________________________ City _______________________ State ______ Zip __________

 

 

Product Information:

                         The frame color on all chairs is Black Hammertone (charcoal) the seats are black vinyl.

 

Quantity __     “Bounce Back” The Fitness Chair  @  $_____. Inc. S&H                       $____________

                        (Comes with Regular Weight Springs 100-250#, sling seat & DVD)

                        Heavy Weight Springs (200-350#) $50 per set*                                    $____________

                        Extra Heavy Weight Springs (300-450#) $75 p/set*                              $____________         

                        Optional Hard Seat with Adjustable Back Straps $25.00                       $____________         

                        Other Accessories _________________________                              $____________                     

                        Sales Tax (6.25% - UT Residence)                                                         $____________         

                                    TOTAL                                                                                      $____________

                        *Additional only at time of original shipment in lieu of regular weight springs.             

                                   Indicates low and high weight of person using The Fitness Chair.

 

Method of Payment:

 

                           _____ Check  _____ Cash  _____ Visa - M/C  _____ Am/Exp  _____ Discover

                                                                       

                 CREDIT CARD # _________ / _________ / _________ / _________   EXP. DATE   _____/_____       

                                 

                                  Verification Number (The three numbers on back of Credit Card)      #__ __ __  

                        

            USTOMER SIGNATURE____________________________________________________________

                                         (SIGNATURE REQUIRED -  ABOVE INDIVIDUAL AGREES TO PAY AS ABOVE STIPULATED)