Orderform1

To place an order online, you may fill out the form below and click the SUBMIT button at the bottom of the form.
Vitaspace accepts VISA, MASTERCARD and DISCOVER credit cards.
Also accepted: check, money order, or wire transfer
Vitaspace sells thousands of nutritional powders in both small and large sizes.
For price quotes or questions on any powder that you need, send an email to
peter@vitaspace.com
or you may call 631-342-1883

PAYMENT OPTIONS

VISA MASTERCARD DISCOVER Mailing CHECK or MONEY ORDER Sending WIRE TRANSFER

CREDIT CARD #

EXPIRATION DATE

3 DIGIT SECURITY CODE ON BACK OF CARD (Optional)

NAME ON CREDIT CARD

COMPANY NAME (Optional)

BILLING ADDRESS (Line 1)

BILLING ADDRESS (Line 2)(Optional)

CITY

STATE or PROVINCE

ZIP or POSTAL CODE

COUNTRY

EMAIL ADDRESS (Required)

TELEPHONE NUMBER (Optional)

IS SHIPPING ADDRESS THE SAME AS BILLING ADDRESS? (Check one)

SAME	DIFFERENT (fill out shipping information below)

SHIP TO NAME

SHIP TO ADDRESS Line 1

SHIP TO ADDRESS Line 2

SHIP TO CITY

SHIP TO STATE or PROVINCE

SHIP TO ZIP or POSTAL CODE

SHIP TO COUNTRY

Use one line per item to type the NAME, AMOUNT and PRICE of the powder you are ordering:

For example: RESVERTROL POWDER 98%, 100 grams = $100.00

ORDER ITEM 1

ORDER ITEM 2

ORDER ITEM 3

ORDER ITEM 4

ORDER ITEM 5

ORDER ITEM 6

ORDER ITEM 7

ORDER ITEM 8

ORDER ITEM 9

ORDER ITEM 10

ORDER ITEM 11

ORDER ITEM 12

ORDER ITEM 13

ORDER ITEM 14

ORDER ITEM 15

SHIPPING = $6.00 for any size order within the United States

INTERNATIONAL SHIPPING: email for quote

TOTAL

Click the SUBMIT FORM button to send your order.

COMMENTS