<<Back to home

Super Hair Energizer printable order form
We understand that some of our customers may feel uneasy about ordering via the Internet. We still want to give those customers an opportunity to try our product. Simply print out this order form (Go to "File" and "Print". THIS FORM WILL PRINT ON TWO PAGES) and mail it along with a check or money order payable to "Sunset Internet Marketing" to:

Hair Energizer .net, 554 Green Tree Cv, Suite 201
Collierville, TN 38017


Please print clearly.

Customer Name:
Address:
City: State: Zip:
Day Phone: Eve. Phone:
 Fax: E-mail:
Qty Description Price Total
  Super Hair Energizer - 1 month supply $27.95  
  Super Hair Energizer - 2 month supply
$46.95
  
  Super Hair Energizer - 4 month supply
$89.95
  
   
 
       
  Daily Shampoo (8oz)
 
  Hair Follicle Stimulator (8oz)
 
  Jojoba Oil (4oz)
 
  Vitamin & Mineral tablets (60 count)
 
       
SUBTOTAL:  
SALES TAX:
(9.25% in TN)		  
SHIPPING (USA ONLY): $6.99
TOTAL AMOUNT: $

 

 

PAYMENT INFORMATION
PAYMENT TYPE:* (Please select one.) No Cash or C.O.D. accepted. Check/money order payments accepted with postal mail orders ONLY.
  Credit Card   Check**   Money Order
** Make checks payable to: Sunset Marketing (checks must be in US dollars ONLY)

CREDIT CARD PAYMENT INFORMATION:
TYPE OF CARD:*
  Visa   MasterCard   American Express
CARD NUMBER:* (Must be 16 digits) EXP. DATE*
    |    |    |    |    |    |    |    |    |    |    |    |    |    |    |    |
CARDHOLDER'S NAME AS IT APPEARS ON THE CARD:*
 
CARDHOLDER'S SIGNATURE:* (Orders can not be processed without signature)
X

Mail your order / check payable  to:

Sunset Internet Marketing
554 Green Tree Cv
Suite 201
Collierville, TN 38017