|
|
DISTRIBUTOR'S
ORDER FORM
Please fill up this form and fax it to: 011-783-7060
| Title |
|
| First
Name |
|
| Surname |
|
| ID
No |
|
| Postal
Address 1 |
|
| Postal
Address 2 |
|
| Postal
Address 3 |
|
| Postal
Address 4 |
|
| Postal
Code |
|
| Contact
Phone No: |
|
I
would like to order:
Product |
Quantity |
Unit
Price |
Total |
|
Memory & Focus
|
|
R100.00 |
|
|
Stress
|
|
R100.00 |
|
|
Seniors
|
|
R100.00 |
|
|
|
|
R100.00 |
|
|
|
|
R100.00 |
|
|
|
|
R100-00 |
|
| Study
Aid |
|
R100.00 |
|
| Packaging
& Postage |
|
|
R30.00 |
| TOTAL |
|
|
|
An
amount of R30.00 will be charged for delivery.
|
|
