The Stretch-assager™ Fax/Mail Order Form
You can print this form directly from your browser.
Fax To: 770-926-9572 or call 770-926-9896
Mail To:
Grid, P.O. Box 23, Woodstock, GA, 30188
We Accept: Visa, Mastercard, American Express, Check or Money
Order.
Quantity ____________________________________
Full Name___________________________________
Street_______________________________________
Apartment or Suite_____________________________
City________________________________________
State/Province________________________________
ZIP/Postal Code______________________________
Telephone___________________________________
E-Mail Address (optional)________________________
Any Special Shipping Instructions_________________
___________________________________________
If using credit card, also complete below. Amex, Visa or MC.
Name on Card_______________________________
Card Number________________________________
Expiration Date_______________________________
Signature____________________________________
Date_______________________________________