OnlineMedinfo

Order Form

BY FAX BY PHONE BY MAIL

( 805 ) 484-1069 ( 888 ) 495-2002 Jafer Nutritional Products, inc

P.O. BOX 328, Camarillo, CA. 93011

BILL TO

Name____________________________________ ADDRESS:__________________________________________

CITY:____________________________________ STATE:______________ ZIP:______________

Contact Tel:________________________________ Email ______________________________________________

SHIP TO ( only if different from "Bill To" )

NAME:____________________________________ ADDRESS:_____________________________________________

CITY:_____________________________________ STATE:______________ ZIP:______________

METHOD OF PAYMENT

_____ VISA _____ MASTERCARD _____ CHECK ( enclosed)

CARD NUMBER : _____________________________________ DATE OF EXPIRATION ____________________

CARDHOLDER NAME :_______________________________________________________________________________

CARDHOLDER SIGNATURE :___________________________________________________________________________

ITEM	QUANTITY	PRICE EACH	TOTAL PRICE



		SHIPPING COST ( Please see chart below)
		7.25% SALES TAX FOR CALIFORNIA RESIDENTS ONLY
		ORDER TOTAL

SHIPPING COST CALCULATOR

Total Price	Shiping cost	Total Price	Shiping cost	Total Price	Shiping cost
$1.00 to 50.00	$5.00	$51.00 to 100.00	$7.00	$101 and up	$ 10.00

Please be ware that we accept only US. Dollars.