Nutrition Discounters

"We Make Healthy Living Affordable!"
Nutritional Supplements, Vitamins, and Weight Loss		 Mail this Order Form to:

148 W. Roosevelt Rd.
Villa Park, IL 60181		 Fax this Order Form:

1-630-279-7289
Bill To (Ordered By):







Fill in Name, Address, and Phone Number above.
 Ship To (Leave blank if same as "BILL TO"):







Fill in Name, Address, and Phone Number above.

METHOD OF PAYMENT: (We reserve the right to ship orders to the billing address only.)

VISA   MasterCard   DISCOVER   AMEX   Money Order (Sorry, no Personal Checks.)

Credit Card Number_____________________________________________   Expiration Date__________________

Signature______________________________________________________

Item Number
Quantity
Brand and Product Name
Size
Price
Total Price
(Price X Quantity)
           
           
           
           
           
           
           
           
           
           
           
           
           
           

Subtotal  
Discounts
(Order $150-$249.99 take 5% off | $250-$349.99 take 10% off | $350 and up take 15% off)
  
Illinois residents add 1.25% Sales Tax  
Shipping ($5.00 if Subtotal is under $100 | Free Shipping if Subtotal is $100 and above)
*These shipping charges apply to orders being shipped via UPS Ground Service.		  
Total Payment (Make money order payable to Nutrition Discounters.)