TO ORDER THE EQUALIZER
PLEASE PRINT FORM, FILL OUT AND
FAX TO HEI AT 301-262-4049
OR MAIL TO: HEI; BOX 2036; Bowie, MD 20718 |
YOU MAY PAY BY CREDIT CARD (VISA OR MASTER CARD), U.S. POSTAL MONEY ORDER OR PERSONAL CHECK (WILL SHIP AFTER CHECK CLEARS)
ORDERFORM
MODEL: |
COST EACH |
NUMBER ORDERED |
TOTAL COST |
| LITE |
$32.99 |
|
$ |
| BOTTLE |
$44.99 |
|
$ |
| Fill in Order Date below |
TOTAL COST ENCLOSED OR BY CARD= |
$ |
|
|
E-MAIL ADDRESS FOR
CONFIRMATION OF ORDER |
|
SIGNATURE
(CREDIT CARDS ONLY) |
|
All information provided on this form is private and will not be shared in any way.
If prices have changed since this form was printed you will be notfied before completing the order. |
FILL OUT TO PAY BY VISA OR MASTER CARD |
| Name on Credit Card |
|
| Tel. # of Card Holder |
|
| Address of Card Holder |
|
| Check one |
VISA |
| MASTER CARD |
|
Card Exp. Date |
|
FILL OUT TO SHIP TO ADDRESS DIFFERENT THAN THE ABOVE |
| Ship To: Name |
|
| Ship To: Address |
|
|