Flex Arms®

Fax Order Form (US ONLY)
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Please print and fill out this form completely and fax it to: (888) 610-5753
 
4 Flex Armss® -  SAVE $150  (FREE SHIPPING**) $649.99
 
3 Flex Armss® -  SAVE $100   $499.99
 
2 Flex Armss® -  SAVE $50 $349.00
 
1 Flex Arms® $199.99
 
4 Flex Arms® Gels Pads -  SAVE $12 $75.99
 
3 Flex Arms® Gels Pads -  SAVE $8 $57.99
 
2 Flex Arms® Gels Pads -  SAVE $4 $39.98
 
1 Flex Arms® Gels Pads $21.99
Shipping Information:
Name:
  
Address:
  
City/State/Zip:
  
Telephone:
  
Email Address:
  
Amount Enclosed:
Write in the amount for the number of Flex Armss you chose:
 $

Shipping and Handling:
 $7.95 Standard  3-7 business days
 $11.95 Priority   2-3 business days
 $22.95 Express 1-2 business days

$
TOTAL ORDER IN US DOLLARS:
 $


Payment Details:

Type of Credit Card:
 
Visa
 
Mastercard
 
Discover
 
American Express
Credit Card Number:
Expiration Date:
_______Month      _______Year
Security Code:
(3 or 4 digit number on back of card)
Signature: