Please fax this order form to:

1.847.841.3700

or send it to:

FitRx.com, Inc.
1629 S. Roselle Rd.
Roselle, IL 60172
Fax-Mail Order Form
Make your money order or cashiers check payable to:

FitRx.com, Inc.

(NO PERSONAL CHECKS)

Product #

Description

Unit Price

Quantity

Total

         
         
         
         

Sub-total

 

Sales Tax (IL add 2.00%)

 

Shipping

6.95

P.O. Box & APO/FPO orders please call (877)GO-FITRX (463-4879) for shipping costs.

 

Total

 

Cashier's checks and money orders received without the correct amount or without shipping charges included will be returned.
Method of payment: Money Order, Cashier's Check (sorry, no personal checks), Visa, MasterCard, Discover and Amex

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Charge My: (If paying by credit card)

 

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