PR Enterprise 
The Healing Powers of Rooibos
 
----------------Online Order Form---------------- 
 
Please provide the following ordering information completely.
    1. Be sure to order in correct quantities that are sold. We will not break up pre-packaged products. 

    2. Provide your e-mail address and phone number so that we can contact you if any part of your order is no longer available or there is a credit card or shipping problem. 

    3. If you would like to order more than 4 different products, then add the additional products in the comments area below, or you can send multiple orders. 

    4. Order Info:  Make check payable to A n D Inc. 163 Summit Ct. - Grand Prairie, TX 75052 
    972-263-6369  Fax:  972-263-1958. Independent Distributor of Zaitek Global Inc.

    Product Descriptions Qty. Your Price Total
      Texas Residents add 8.25% sales tax
          Sub-Total
    Shipping and Handling Charges will be added when order is received. 
    Please provide complete street address.  

    Credit Card Information  
    Credit Card
    Cardholder Name
    Credit Card Number
    Expiration Date
    Customer Service Phone Number 
    On Back Of Credit Card (Optional)
      Cardholders Account Information
    Name
    Company
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    * Phone
    Fax
    * E-mail
    * Denotes this MUST be filled in case we need to contact you. 

      COMMENTS / SPECIAL INSTRUCTIONS
       

----------------Online Order Form---------------- 
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