EMS MAIL ORDER FORM

Comfort Body Shapers International.

2245 Kennedy Road Suite 203A Scarborough, Ontario M1T-3G8 CANADA TEL:1-800-761-2639 FAX:(416) 298-2882 OUTSIDE NORTH AMERICA CALL: 1-416-298-2639

EMAIL: service@bodyshapers.com

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Or mail to:
Comfort Body Shapers International
2245 Kennedy Road Suite 203A
Scarborough, Ontario
M1T 3G8
Canada
Make all your checks or money orders payable to Comfort Body Shapers International.

First Name:__________________________ Last Name:__________________________

Shipping Address
Street # & Name:_______________________________________

City:___________________ State/Province: __________________

ZIP/Postal Code: _____________ Country:___________________

E-mail:________________________

Phone (work):________________ Best time to call you :_____________ Time Zone:_______

Phone (home):________________ Best time to call you :_____________ Time Zone:_______

Method of Payment

(Cheque , Money Order , Credit Card):_________________________

Name on Credit Card:__________________________

Mailing Address
Street # & Name:__________________________________

City:___________________ State/Province: ________________

ZIP/Postal Code: _____________ Country:___________________

Credit Card Type (Visa, Master Card, American Express): ________________

Credit Card No:__________________________ Expiry Date:_________________

Signature:___________________

Customer service phone # on back of credit card:__________________________

FILL OUT THE FORM BELOW FOR YOUR ORDER

**ORDERING INFORMATION**
ITEM #	PRODUCT #	PRODUCT DESCRIPTION	QUANTITY	UNIT COST	EXTENDED COST
1.
2.
3.
4.
5.
FREIGHT
SUB-TOTAL
TAXES***

ALL PRICES ARE IN U.S DOLLARS
except for Canadian residents who may pay in Canadian dollars as long as your
cheque, money order, or credit card is with a Canadian Banking Institution.

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