Ordering

You can download this order form in rich text(.rtf) OrderForm.rtf
or document(.doc) format OrderForm.doc and mail, e-mail or fax it to us.

Name____________________________________________________________ 

Organization ______________________________________________________

Address __________________________________________________________

City  ________________________________ State______ Zip _______________

Bus. Phone (___)_______-_____________  FAX (___)_______-______________

E-mail ____________________________________________________________

BILL MY  ____VISA   ____Master Card   ____Am. Ex.   ____Payment Enclosed

Name as it appears on card ___________________________________________

Credit Card Number   __ __ __ __     __ __ __ __     __ __ __ __      __ __ __ __ 

Expiration Date ______/______/______

Bill my organization:  Purchase Order # ________________

Billing Address (If different from above):
 

 

QTY. ITEM ORDERED UNIT PRICE PRICE
    Body/brain BOOGIE VIDEOTAPE    
    Body/brain BRANCHES BOOKLET    
    Brain BOOGIE BUTTONS    
    QUICK QUEST Wellness COUPONS.    
    Do It!  Pursue Wellness BUTTONS    
    Health Care-toons (Undated) Calendar    
    Health Care-toons Journal    
    Toon Ups!    
    BRANCHES – Teaching Enhancement Program BOOKLETS    
    BRANCHES PROGRAM GUIDE    
    Teaching and Learning A.L.I.V.E! Guide    
    Body/brain BOOSTER ACTIVITY Book    
    BreakOUT of the BOX Kit    
       
       
 
(Make payment to Wellness Quest)  
TOTAL
 

Wellness Quest   1541 7 ½ Avenue NE   Rochester, MN  55906    1-888-388-WELL
Phone: 1-507-281-3143   Fax: 1-507-282-0084   E-mail: wellnessquest@charter.net

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Last modified: January 25, 2007 | © 2006 Wellness Quest Inc. All rights reserved | Webmaster: Mah