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CUSTOMER INFORMATION:

Name    _________________________________________________________

Address _________________________________________________________

City    _________________________ State _______ Zip _____________

Phone   _________________________________________________________

E-Mail Address __________________________________________________

SHIPPING INFORMATION:

(Fill out only if different than above address i.e. a gift)

Name    ________________________________________________________

Address ________________________________________________________

City    _________________________ State ______ Zip _____________

Gift Message    ________________________________________________

PAYMENT INFORMATION:

Select type of payment:

Name as it appears on card _____________________________________ 

Credit Card Number         _____________________________________

Expiration Date (mm/yy)    _____ / _____

SUBMIT ORDER:

Snail Mail: Fit For Life, 575 75th Avenue , St Pete Beach, FL  33706
Phone: 1-888-479-9355  (8:00 a.m. to 5:00 p.m. EST Monday-Friday)
Fax: 727-367-0402 (24 hours per day)

Thank You For Shopping With Us!

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