Automatic Shipment Form

Directions: Please fill out the following form, then click on the “submit” button.
The auto shipment information will be forwarded to us, and we will set up your
auto shipment. We will then contact you by email or phone to let you know that it is set up.

Name	:*
Address	:
City	:
State	:
Zip code	:*
Phone #	: (Day)
Phone #	: (Evening)
Email Address	:*
Frequency of Shipment (Every ___days, every ___ weeks, every ___ months)	:
Product Description - Type of product(s) and size to be shipped	:*
Start Date of Auto Shipment	:
Comments/Instructions	:
Credit Card Information	:	We will call you to get the credit card number and expiration date. Or if you would like to use the same credit card that you used for your last order, please tell us in the "Comments/Instructions" area below.

*Note:
Your auto shipments can be changed or cancelled at any time with a minimum of five (5) business days.

Products returned within 30 days of purchase will receive a 100% refund (minus shipping charges).

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