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Printable / Faxable Order Form

Print and mail this form to:

Larry P. Key, Nationally Certified Reflexologist
3927 W. 21st Place
Panama City, FL 32405

Please make checks payable to Larry P. Key

Fax credit card orders to: 1-555-123-4567


Name: _____________________________________________________

Address (No P.O. boxes please): _____________________________________

City: _______________________ State: ________ Zip: ___________

Daytime Telephone (please include area code): ____________________

Item Name Price Qty. TOTAL
 Roller~Flex (patent pending) $ 15.00     $
 The Genesis Factor 100% Colostrum  $ 35.00     $
 Toner "The Juice" $ 45.00   $
 Metabolizer 2000 $ 35.00  $
 Natural Herbal Sleep Aid $ 20.00   $
 St. John's Wort with Ginkgo Biloba $25.00    $
 Super MSM $ 25.00   $
 Osteo Tek Liquid Calcium Complex $25.00    $
    ORDER
SUBTOTAL:
$
    SHIPPING $ 6.00
    GRAND
TOTAL:
$

If paying by credit card, please enter your card number below:

(Circle One)
VISA  |  MasterCard

Card No.: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Expiration date (MM/YY): ___________ Name on card: ____________________________

Billing Address: __________________________________________________________

By signing below, I authorize Larry P. Key to charge my credit card the amount listed as the "Grand Total" on this order form.

_____________________________________________________

Authorized signature of account holder               

Please be advised that orders paid by personal check will not be shipped until your check is cleared. This takes 7-10 days and means that it could be up to 2 weeks before you receive your order. Sorry, but we cannot accept CODs at this time.

Additional Shipping Information

UPS 2nd Day, add $10.00 to shipping amount.
UPS Next Day, add $15.00 to each of the above amounts.
Hawaii and Puerto Rico must be shipped UPS 2nd day.
Email us about international rates.

Larry P.Key

(850) 522-1705; Email: lkeykeyman@knology.net