Print
out and complete this order form,
and send with your check, money order, or payment information to:
Gay
Riley, Lipo-Visuals, Inc.
1510 Braeburn Drive
Richardson,
TX
75082
(214) 244-0429 Phone
(214) 722-1935 Fax
info@lipovisuals.com
| Order
Form |
| Product
|
Price
|
QUANTITY
|
TOTAL
|
| Lipo-Visuals
Favorite Foods- NEW! |
$90.00
|
|
|
| Sugar
Drinks 10 pack-NEW! |
$90.00
|
|
|
| FIBER
VISUALS 12-PACK
- NEW! |
$50.00
|
|
|
| Lipo-Visuals
Deluxe Set (36 Tubes) |
$155.00 |
|
|
| LIPO-VISUALS
12-PACK |
$50.00
|
|
|
| LIPO-VISUALS
Condiments 12-pack |
$50.00
|
|
|
| LIPO-VISUALS
FAST FOOD PACK |
$50.00
|
|
|
| SUGAR
VISUALS DELUXE SET (36 TUBES) |
$155.00 |
|
|
| SUGAR
VISUALS 12 PACK |
$50.00
|
|
|
| SUGAR
VISUALS Drinks 12 pack |
$50.00
|
|
|
| SUGAR
VISUALS FOR KIDS |
$50.00
|
|
|
|
Acrylic
36 hole display rack |
$35.00 |
|
|
|
Acrylic
12 hole display rack |
$25.00 |
|
|
2 for 1 Special Offer!
The
Pocket Personal Trainer &
Daily
Records: More from The Pocket Personal Trainer |
$12.00 |
|
|
|
SUB-TOTAL
|
|
| $12.00
UPS ground track shipping for each Lipo-Visuals or Sugar-Visuals
order less than $200; $3.00 for each book ordered. (US Orders)
Orders over $200 free shipping |
SHIPPING |
|
|
TOTAL
|
|
|
Name:
|
|
Address:
|
|
City:
|
|
State:
|
|
Zip:
|
|
Telephone:
|
|
Fax:
|
|
Email
Address:
|
|
Billing
Address:
|
|
Circle
one: Mastercard Visa
Check
Money Order
|
|
Card
#:
|
|
Expiration
Date:
|
|
Name
as appears on Card:
|
|
