AMTIL Inc. (Animal Massage & Therapies)
RETAIL ORDER FORM
Name_____________________________________________ Phone____________________ Address______________________________________________________________________ City___________________________________ State__________ Zip__________________ Email_____________________________________________ Fax______________________
SHIPPING ADDRESS IF DIFFERENT FROM ABOVE
Name_____________________________________________ Phone____________________ Address_____________________________________________________________________ City___________________________________ State__________ Zip__________________
Product Code Product Name (size, color, etc.) Unit price # units Total price
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Subtotal ___________ Discount/Coupon (Enter code here__________) ________ Shipping/Handling (please allow 2-3 weeks for standard delivery ________ Sales Tax (NC residents only) ________
Total ________
PAYMENT OPTIONS
Mail check or money order payable to AMTIL Inc. to: AMTIL Inc. PO Box 366 Pleasant Garden, NC 27313
Credit Card Information
Name on Card___________________________________________ Card Type_________________________
Card #_______________________________________________ Exp Date______________ CVVC_______
Questions or comments? Contact@amtil.com or 866-62-AMTIL (866-622-6845) RETAIL ORDER FORM CONTINUATION PAGE
Product Code Product Name (size, color, etc.) Unit price # units Total price
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Total (carry to order form page 1) ___________
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