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Order Form
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Item #
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Description
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Quantity
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Price
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Subtotal
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| _________ | __________________________ | ____________ | ________________ | __________________ |
| _________ | __________________________ | ____________ | ________________ | __________________ |
| _________ | __________________________ | ____________ | ________________ | __________________ |
| _________ | __________________________ | ____________ | ________________ | __________________ |
| _________ | __________________________ | ____________ | ________________ | __________________ |
| _________ | __________________________ | ____________ | ________________ | __________________ |
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Order Total:
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__________________ | |
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Discount:
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__________________ | |
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Shipping:
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__________________ | |
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Total:
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__________________ |
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Name:
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__________________________________________________________________________ |
| __________________________________________________________________________ | |
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Address:
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__________________________________________________________________________ |
| __________________________________________________________________________ | |
| __________________________________________________________________________ | |
| __________________________________________________________________________ | |
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Phone:
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__________________________________________________________________________ |
Method of Payment
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Check | |
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Mony Order | |
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Bill Me | |
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Visa | |
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Master Card | |
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American Express |
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Credit Card#
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____________________________________________ | Exp.Date | ________________ |
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Signature
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______________________________________________________________________ | ||
Note: Make Check or Money Order payable to Rich Spa LLC.
| Rich Spa LLC. | |
| 140 Main Street | Phone: 315-858-9046 |
| P.O. Box 9 | Fax: 315-858-0494 |
| Richfield Springs, NY 13439 | Email: contact@richspa.com |