Order Form

Balut Health Enterprises, 4923 Woodland Grove Ave. NW, Warren, OH 44483-1719,  USA

Ship to:

Name:                                                                                          Email:                                                   

Address:                                                                                                                                                   

City:                                                                       State:                            Zip:                                        

Home Phone:    (            )                                         Work Phone: (            )                                             

Item Number Quantity Description Unit Cost Total
         
         
         
         
         
         
         

Merchandise Total

Shipping and Handling

 Sub-Total  
Sales Tax       OHIO 5.5%  
$1.00  to $50.00

$50.01 to $150.00

Each additional $50.00 add

  $8.00

 $12.00

 $4.00

 S & H  
Total Due  

Mail or Fax to:  Balut Health Enterprises, 4923 Woodland Grove Ave. NW, Warren, OH 44483-1719,  USA

Fax: (330) 299-0554, or call 1-800-573-6240 to leave Order on Voice Mail

Terms: Check (made payable to George S. Balut), or Discover, Visa, & Mastercard

 Note: There is a $25.00 minimum on all credit card orders

Card Number:                                                        Expires:                                 

Signature:                                                                                                      

Please allow 4 to 6 weeks for delivery.  15 Day return policy with original receipt.  NSF Checks $35 service charge.  Due to market fluctuations prices are subject to change without notice.

Copyright 2007 Balut Health Enterprises