ImmuneForce Online Order Form

Order Form

IMPORTANT
1. You can either submit this form online; or
2. Print the form, fill it out, and send by mail or fax (click here for contact information).
3. If paying by Visa or MasterCard, you may call our 24 Hour Booklet Ordering Hotline at (877) 280-1647.
4. If ordering by mail, you may pay by personal check, money order, or credit card. We do not accept faxed checks.

Last Name:
First Name:
Address: UPS requires a street address. No PO Boxes please.*
City:
State:	Zip Code:
Phone Number (optional):
Email:
Select Self Mailer Brochure Quantity	$.25 per/100 – 499 brochures $.22 per/500 – 999 brochures $.20 per/1,000 or more brochures Shipping & handling of $5 for 1st 100 brochures, then $4 for every 100 brochures thereafter . Tennessee Residents add 9.25% sales tax .
Select Brochure Mailing List Quantity:	$.15/label + Shipping and Handling of $4.00. Tennessee Residents add 9.25% sales tax.
	Would you like to have your self-mailer brochures autoshipped to you each month? Yes No
	Autoship Brochure Quantity (100 minimum):
	Autoship Brochure Mailing List Quantity (100 minimum):
	Which day of the month would you like your Self-Mailer Brochures shipped? 1st 15th
	Which month would you like your Autoship to begin?

Select Booklet Quantity:	$.35 /booklet + $7.00 per 100 booklets shipping and handling. Tennessee Residents add 9.25% sales tax
Select Booklet Mailing List Quantity:	$.15/label + Shipping and Handling of $4.00. Tennessee Residents add 9.25% sales tax.
Select Opportunity Postcard Quantity:	$.10 /postcard + Shipping and Handling of $5.00 for first 100 cards, then $4.00 for every 100 cards thereafter. Tennessee Residents add 9.25% sales tax
Select Postcard Mailing List Quantity:	$.15 each + Shipping and Handling of $4.00. Tennessee Residents add 9.25% sales tax.
Please Charge My:	Master Card Visa
Credit Card Number:
Expiration Date:
Name on Card:
Signature (for fax and mail orders only):	___________________________
Kincannon Hill, Inc. 5012 Kincannon Dr. Nashville, TN 37220 Phone: (877) 280-1647 Fax: (866) 820-5162 info@immuneforce.com