GN=TOP COLSPAN="5">CARDHOLDER'S SIGNATURE:* (Orders can not be processed without signature)
X

Mail your order / check payable  to:

Hair Vitamins
PO Box 901
Grayson, GA 30017

888-909-1658 
(toll free ordering ~ 9-7 Eastern Time ~ Mon.-Fri.)

You may fax this to 208 575-4525 (if paying with Credit Card)

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<Hair growth products    Hair-Growth-Products.com 
Printer Form for Mail Order (Go to "File" and "Print") or Order Online
Please print clearly. Fields marked with an asterisk (*) are required to process this order.
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Customer Name:
Address:
City: State: Zip:
Day Phone: Eve. Phone: Fax: E-mail:
Qty Item Description Price Total
  HEVF4 Hair Energizer Vitamins™ 2 month supply  

$24.95

  
  HEV Hair Energizer™ Vitamins (3 bottles - 60 tablets per bottle) (3 month) $34.95  
  HEFS Hair Energizer™ Vitamin Shampoo  (16 oz  per bottle)  (2 month) $18.95  
  HEV4 Shen Min Hair Nutrient™  ( 1 bottle - 90 tablets per bottle) (1 month) $17.95  
  HFT Hair Growth Kit w/ HE Vitamin (2 month) and Vitamin Shampoo $32.95  
SUBTOTAL:  
SALES TAX:
(8.25% in TN)		  
SHIPPING (USA ONLY): $3.95
TOTAL AMOUNT: $
PAYMENT INFORMATION
PAYMENT TYPE:* (Please select one.) No Cash or C.O.D. accepted. Check/money order payments accepted with postal mail orders ONLY.
  Credit Card   Check**   Money Order
** Make checks payable to: Hair Vitamins (checks must be in US dollars ONLY)

CREDIT CARD PAYMENT INFORMATION:
TYPE OF CARD:*
  Visa   MasterCard   American Express
CARD NUMBER:* (Must be 16 digits) EXP. DATE*
    |    |    |    |    |    |    |    |    |    |    |    |    |    |    |    |
CARDHOLDER'S NAME AS IT APPEARS ON THE CARD:*
 
CARDHOLDER'S SIGNATURE:* (Orders can not be processed without signature)
X

Mail your order / check payable  to:

Hair Vitamins
PO Box 901
Grayson, GA 30017

888-909-1658 
(toll free ordering ~ 9-7 Eastern Time ~ Mon.-Fri.)

You may fax this to 208 575-4525 (if paying with Credit Card)