Order Form

Vital Life Corporation Pty Ltd  (ABN 89 007 860 696)

P O Box 1262
Waverley Gardens  VIC  3170  
Tel: (03) 9005 2266                                             Email: sales@vitallife.com.au
Fax:(03) 9005 2269                                            Website: www.vitallife.com.au

 Name: …………………….……………………

 Delivery Address: ..………….……………

 …..……………………………………………….

 ……..………………….Post Code:  …….…

 Tel: ……………………………………………..

 Email: ..………………………………..………

 Payment Details: (Circle One Type)

 M/card B/card Visa Amex Money-Order Cheque Cash

 Card No. ..…………………………………………………..

 Exp …….. / ……..

 Name on Card ……………………………………………..

 Signature .……….……….…………..…………………….

Product

Unit Price

Quantity

Value (AUD)

 Vital Life

$60

 Vital Edge

$60

 Vital Oxygen – 50ml

$10

 Vital Oxygen – 250ml

$20

 Vital Oxygen – 500ml

$35

 Vital Oxygen – 1 Litre

$60

 Vital Fish Oil – 200 capsules

$25

 Vital Body Balm – Lavender - 125ml

$15

 Vital Body Balm – Lime -        125ml

$15

 Vital Body Balm – Lavender - 500ml

$45

 Vital Body Balm – Lime -        500ml

$45

 Vital Muscle Eze – 125ml

$25

 Vital Muscle Eze – 500ml

$85

 Vital Skin Soothe – 125ml

$28

 Vital Skin Soothe – 500ml

$90

Discount Rates (AUD)

$100 to $199      - 5%
$200 to $499      - 10%
$500 to $599      - 15%
Over $599         - 20%

SUB-TOTAL     

Discount

TOTAL

Plus standard freight charges