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1.855.642.2011 Order Form

Web: • 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________________


Card #_______________________________________________________

P.O. Box/Street_________________________________________________

Cardholder’s Name_____________________________________________


Cardholder’s Address____________________________________________

Daytime Phone________________________________________________


Email__________________________________ Fax__________________



Item No.



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