WEB SITE ORDER FORM
Please copy and print
out this form and fill-in the requested information and mail it along with your payment to the address provided below:
Name: _____________________________________________________________________
Address: ____________________________________________________________________
Phone #: H: ___________________________
Cell: ______________________________
Email Add: ______________________________ / _________________________________
Please provide us wit at least three possible domain names (we suggest that they be as
short as is possible): .Examples: www.godowdy.net
or www.gochrisd.com or www.johnastokes.com or www. goslking.com or whatever!
<> 1: ________________________________
<> 2: ________________________________
<> 3: ________________________________
Please
provide us with some information on the type of business / sales that you are
in as well as contact information!
______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_________________________________________________________________________________
________________________________________________________________________________
Payment Method:
We accept: __
Check, __ M/O, __ Visa __ M/C __ A/E __ Disc
Card # ___________ /___________ / ___________ / ____________
Exp. date: __________ /__________ /___________
Please add the 3 digit security # on back of card here: ____
____ ____
Name on Card: _________________________________________________________
SIGN
Here: _______________________________ Date: _______/_______ /_______
Complete billing address of card:
___________________________________________
________________________________________________________________________
All credit cards are payable to DOWDYNSON.COM / Healthy Life Products
Please mail your order to:
DOWDYNSON.COM
3337 WEST FAIRCREST DRIVE, ANAHEIM, CA 92804-3014
Ofc: 1-866-463-6939 or VM:
1-800-844-9639 x 4544 or Cell: 714-273-5223
Email: aacwcd@yahoo.com
Please give us about 10 to 15 days to process your website order!
