| Vital Chi |
| 500 W. Main Street |
| Arlington, TX
76010 |
| Phone (817)
469-8823, Fax (817) 292-3335 |
| www.vitalchi.com |
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| Sold To: |
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Ship To: |
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| Product Description |
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Product
Description |
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| Credit Card |
Check # |
Cash |
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Subtotal |
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| Name on Credit Card |
Shipping & Handling |
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| Credit Card # |
Sales Tax |
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| Exp Date |
Signature |
Total |
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