Vital XL Vital XL Mail / Fax Order Form
Simply Mail or fax with payment to:
Sherpa Select Marketing Ltd.
2516 Bridge St.
Victoria, BC, Canada, V8T 5H3
Fax Number: 1.800.760.4914
Toll Free: 1.877.647.4242

Billing Information:

Shipping Information (if different from billing)

Name: Name:
Address: Address:
   
City: City:
State/Province: State/Province:
Country: Country:
ZIP/Postal Code: ZIP/Postal Code:
Phone:  
E-Mail*:  
*Required for order confirmation and order tracking. We do not sell E-Mail Addresses

Product

Price

QTY
Vital XL $29.99  
Buy 2 Get 1 Free $59.98  
Buy 3 Get 2 Free $89.97  

Payment Options

 
Visa   MasterCard   Money Order**  
Card Number:
Card Expiration Date:
Signature:
**Please make Money Order payable to Sherpa Select Marketing Ltd.
Use International Money Orders ONLY
Subtotal:  
Shipping:  
USA - $6.95
Canada - $15.00
International - $25.00
Total:  
ALL PRICES IN US FUNDS
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