Wellness Systems International
   Order Form

Print this form on your printer and fax or mail your order to:

Wellness Systems International                    P.O. Box 108                  McKenna, Washington 98558

Phone: 360-894-3844           Fax: 360-894-1745         Office Hours: 10am to 6pm   PST         Monday through Friday


Name:
Address:
City:                                                                                State:                     Zip
Phone No:                                     Fax No:                                    Email:

If ship to address is different from above fill out this area.
Name:
Address:
City:                                                                                State:                     Zip

Please call or fax us for shipping and handling charges.

Quantity
Description
Price
Total
x x x x
x x x x
x x x x
x x x x
x x x x
x x x x
x x x x
x
Shipping and Handling charge
 x x
x x
Order Total
 x


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