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1.855.642.2011

MyHealthyChurch.com Order Form

Web: MyHealthyChurch.com • Phone: 1.855.642.2011 Fax: 1.877.840.5100 • Intl. Phone: 417.866.8014 • Intl. Fax: 417.862.0414 Hours: Monday-Friday

7 a.m. - 5:30 p.m. (CT)

Ship to______________________________________________________

Ad code CS M E T H O D O F PAY M E N T

Check or Money Order Enclosed_________________________________ Purchase Order Number_______________________________________

___________________________________________________________

Exp. Date________________

Attn.________________________________________________________

Card #_______________________________________________________

P.O. Box/Street_________________________________________________

Cardholder’s Name_____________________________________________

City/State/Zip__________________________________________________

Cardholder’s Address____________________________________________

Daytime Phone________________________________________________

___________________________________________________________

Email__________________________________ Fax__________________

Signature____________________________________________________

Quantity

Item No.

Description

Subtotal

My Healthy Church 1445 N. Boonville Avenue Springfield, MO 65802-1894 For expedited orders, additional charges may apply. International orders billed actual postage charges. Postage charged on all items. Due to changes in carrier costs, shipping rates are subject to change.

Unit Price Total Price

Postage Estimate Grand Total Please allow 8-14 business days for delivery. For normal shipping, provide postal address. Rush orders MUST have street address. May generate additional charges.

Postage Charges 8-14 business days $0.01–$24.99 $5.99 $25.00–$49.99 $6.99 $50.00–$99.99 $7.99 $100.00–$249.99 10% $250.00 and over 9%

My Healthy Church Order Form  
My Healthy Church Order Form