E.M.S MAIL ORDER FORM

Comfort Body Shapers International
7 cLAIR RD. WEST BOX 27040
GUELPH, ONT., N1L-0C1, CANADA
TEL: (519) 836-2639 or 1-800-761-2639
FAX: 1-(519) 836-2880
service@bodyshapersg.com

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Print this form, using print command from the file menu, then fill it out.
Fax the form to (519) 836-2880
Or mail it to Comfort Body Shapers International
7 Clair Rd. West Box 27040A
Guelph, Ontario
N1L-0C1
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:__________________________

UNDERLINE THE PRODUCTS YOU'RE ORDERING BELOW

XT4SP      2 CHANNELS [ 8 Pads EMS Unit]             REG. PRICE   $ 399.00   SPECIAL  $189.00
XT6SP      3 CHANNELS [ 10 Pads EMS Unit]           REG. PRICE   $499.00   SPECIAL  $359.00
BP8SP      4 CHANNELS [ 12 Pads EMS Unit]           REG. PRICE   $599.00   SPECIAL  $379.00
BM1008BI      4 CHANNELS [16 Pads EMS Unit]    REG. PRICE   $ 699.00   SPECIAL  $549.00
BM1012BI      6 CHANNELS [20 Pads EMS Unit]    REG. PRICE   $ 899.00   SPECIAL  $579.00
BM1016BI      8 CHANNELS [24 Pads EMS Unit]    REG. PRICE   $1200.00   SPECIAL $629.00
HS-901             [Bust Shaper Unit]                               REG. PRICE    $399.00    SPECIAL $249.00
PRO12      6 CHANNELS [ 20 Pads EMS Unit]           REG. PRICE    $ 1300.00    SPECIAL  $629.00
PRO16      8 CHANNELS [ 24 Pads EMS Unit]           REG. PRICE    $ 1600.00    SPECIAL  $729.00
PROT20      6 CHANNELS [ 28 Pads EMS Unit]           REG. PRICE    $ 1900.00    SPECIAL  $849.00

SHIPPING RATES

Ground Shipment [1-2 Weeks] Within N.America only                              $15.00
Express [1 - 2Business day] Within N.America only                              $65.00
Expedited [2 - 2 Business days] Within N.America only                               $49.00

International Outside N.America CALL/EMAIL FOR RATE.

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 and shipment is within Canada.

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e-mail. We would love to hear from you.