Blue Rock - Phone Fax and Mail Order Form

To Phone Your Order...

To Fax or Mail Your Order...

Call us at 1-315-295-1236 Ext. 1

Office hours are Monday-Friday
8:30AM-4:30PM US Eastern Time

No need to fill out or print the Order
Form if you are ordering by phone.

**Print This Form After You Fill It Out
1)	Fill out the form below. You will NOT be submitting this form over the internet. To Fax your order, fax to 1-315-468-5818 24 hrs/day. To Mail your order, use the address below.

2	Once you've chosen product, shipping and tax options: Print and either fax or mail this page.

Product

Quantity 1

Quantity 2

Quantity 3

Quantity 4

Quantity 5

Amount

ProSupershield

$53.95

$48.56

$45.86

$44.24

$42.62

Product

Quantity 1

Quantity 2

Quantity 3

Quantity 4

Quantity 5

Amount

Vital Mega 3

$44.97

$42.83

$41.57

$40.31

$38.97

Billing Address: *required | Shipping Address is the same as the Billing Address

*Name:
*Address:
*City:
*State:
*Country:
Non US Province/State:
*Zip/Postal Code:
*Phone:
*E-Mail:

Shipping Address: *required

*Name:
*Address:
*City:
*State:
*Country:
Non US Province/State:
*Zip/Postal Code:
*Phone:
*E-Mail:

Credit Card Orders: *required

*Card Type:
*Name on Card:
*Credit Card#:
*Expires:	/ (xx / xxxx)
*Signature:
	__________________________________________________

For Checks/Money Orders: (fill out only shipping address above)

Make check payable to:

Holistic Blends, Inc
Only Money Orders or Bank Checks accepted in USD.
Mail check with this form to the following address:
Holistic Blends, Inc.
PO Box 359
Syracuse, NY 13209-0359

Shipping:

	UPS Ground (1 - 5bus. days) UPSG - $3.95 (+$.95 per item) USD
	UPS 2-Day (2 bus. days) UP2 - $9.95 (+$.95 per item) USD
	UPS 3-Day (3 bus. days) UP3 - $6.95 (+$.95 per item) USD
	Express Mail (1-2 bus days) EML - $17.85 (+$.95 per item) USD
	UPS Next Bus. Day UPN - $25.35 (+$.95 per item) USD
	Outside of US (9-18 days) IFCM - $10.50 (+$.95 per item) USD
	Outside of US Int'l Priority (6-9 days) FXP - $16.00 (+$.95 per item) USD

$	+	$	+	$	=	$
Order Amount		Tax ( If Applicable)		Shipping		Total Investment

Click here to print this form

All orders received by 8:00 AM (M-F) U.S. Eastern Standard Time ship the same day