PRINTER ORDER FORM
For Orders or If You Need Information Please Call or Fax: 480 899-4463 USA, Monday-Friday
or Complete and Mail or Fax This Form To: Larry Smith, C/O 3619 E Verdin Road, Phoenix, Arizona 85044 USA
(Use additional sheets if necessary)
(If ordering NSP products:Nature's Sunshine Products Distributor: Elvire van Leeuwen-Smith) Distributor #: 522388-4

COMPLETED BY:

Name _________________________________________________________________

Address ______________________________________________________________

City _________________________ State ________________Zip _____________

Country ______________________ Phone _________________________________

SHIP TO:


Name _________________________________________________________________

Address ______________________________________________________________

City _________________________ State ________________Zip _____________

Country ______________________________________________________________



PAYMENT METHOD:	[ ]  Check	 	[ ] Money Order	
[ ] VISA	[ ]MC	[ ] Amex	[ ]Discover



Signature _______________________________  Card #:_____________________

Name on Card: _______________________________ Expire Date: _____________________

ITEM/STOCK NO.
DESCRIPTION
QTY
TOTAL
(U.S. Funds)
 
























    Sub-Total _________ +Shipping__________ = Total Order____________
Shipping Charges - U.S., Hawaii, & Alaska
Order Total:		Shipping
Up to $12		$3.25
$12.01 - $25		$4.25
$25.01 - $50		$5.25
$50.01 - $100		$6.25
$100.01 and up		$7.25


Allow 10 - 14 days for delivery
Shipping Charges - Europe, Australia & Canada
Order Total:	 Europe	 Australia	Canada
Up to $12	 $6.75	 $8.75		$4.75
$12.01 - $25	 $8.50	 $11.50		$5.95
$25.01 - $50	 $11.75	 $15.75		$6.75
$50.01 - $100	 $13.50	 $19.75		$7.75
$100.01 and up	 $16.75  $25.75		$8.75


Allow 2 - 3 weeks for delivery