Please complete all items below and mail to :

Mail Orders, FitnessMountain.com
P.O. Box 1928
Noblesville, IN  46060
Order Information
Item Quantity   Manufacturer   Product  Price
Item Quantity   Manufacturer   Product  Price
Item Quantity   Manufacturer   Product  Price
Item Quantity   Manufacturer   Product  Price
Item Quantity   Manufacturer   Product  Price
Customer Information Shipping Information
Full Name

Address 1

City                                               State        
     
 ZIP Code

Telephone # (only used if there is a problem with your order)
Email Address

Is Shipping Information the same as Customer Information?
NO (please complete) YES (please skip to Payment)
Full Name

Address 1

City                                               State        
    
ZIP Code
Telephone # (only used if there is a problem with your order)
Order notes for Shipping Company?

Payment Information
Please select one of the following payment methods

 Money Order made payable to FitnessMountain.com, P.O. Box 1928, Noblesville IN 46060
 PayPal Payment with funds requested from PayPal account
 MasterCard : 
       Name   Card Number  Exp Date
Visa : 
       Name   Card Number  Exp Date
All Mail Orders are shipped via UPS Ground Service. Your order will incur shipping charges based on actual UPS Ground shipping charges plus a $.50 Handling Fee.
6% Sales Tax will be added to all Indiana sales.
By signing and dating this document, I fully understand that I am placing an order for the above products and I will be charged accordingly if paying by Credit Card or PayPal services.

 Signature :__________________________________________________  Date : _______________________

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