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PO BOX 669 Hammond, LA 70404 FAX (985) 345-3362 Toll Free (800) 449-9861 FAX IT IN OR MAIL IT Email address: mikeafitness@hotmail.com SHIP TO INFORMATION Name:______________________________________________ Address:___________________________________________ City:________________________________ State:_______ Zip:____________ Phone:____________________ _______________________________$____________$___________________ _______________________________$____________$___________________ _______________________________$____________$___________________ _______________________________$____________$___________________ _______________________________$____________$___________________ _______________________________$____________$___________________ _______________________________$____________$___________________ _______________________________Shipping Cost $___________________ _______________________________Order Total $___________________ [__]Check Enclosed [__]Money Order [__]Electronic Check $______________ Electronic Check #______9 Didget Bank Routing #_____________ Account #________________ If you are using a check or our Elecronic Check Service; Please fax/email or send a copy of your drivers licence also. Please Charge my: [__] AMEX [__] VISA [__] MASTERCARD [__] DISCOVER I hereby authorize you to debit my credit card/electronic check as payment for the above described merchandise: Credit Card #:______________________________________ Exp Date:__________________ Amount:_________________ Street___________________City:________________ State:____ Signature:___________________________________________ Date:__________ |
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Information and Service Line
We Proudly Accept All Major Credit Cards and VERIFIED CHECK PAYMENTS 
EMAIL CONTACTS: CEO/Sales/Service Accounting/Web Designer
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CLICK HERE TO FINANCE IT (90 DAYS SAC/12 Mo Contract)
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