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PRODUCT INFORMATION |
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Quantity |
Product Description |
Total Price
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| Premiere Pak (1 person) Best Buy on the Internet | $1195.00 |
|
| Premiere Pak (couple) | $2050.00 |
|
| Premiere Pak (quad) | $3695.00 |
|
|
Gourmet Pak (1 person)
|
$1595.00 |
|
|
Gourmet Pak (couple)
20% discount |
$2775.00 |
|
|
Family Pak - Best Seller
|
$3795.00 |
|
|
Supreme Pak (1 person)
|
$1395.00 |
|
TOTAL |
$
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CUSTOMER INFORMATION |
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Name (Last, First, Middle Initial) |
Street Address (No PO Boxes) |
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City |
State Zip |
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Day Phone |
Evening Phone |
SHIPPING INFORMATION
(if different from above) |
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Name (Last, First, Middle Initial) |
Street Address (No PO Boxes) |
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City |
State Zip |
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Day Phone |
Evening Phone |
Complete the following ONLY if you are printing this form for mail/fax orders |
| Card Number - - - |
| Expires(mm) (yyyy) |
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