If you prefer you may MAIL or FAX an order form to the gift shop. Simply PRINT this form, fill in the information and mail along with your check, money order, or credit card information. For items available in sizes and colors, please specify the desired size and color. Be sure to figure your total order price which includes shipping, taxes and handling charges. Note: All items may not be in stock when your mail form arrives and may need to be back ordered. Prices are subject to change without notice. (You will only be charged for items when shipped.) Mail orders to:

Heavenly Diet Store 4621 Van Nuys Boulevard Sherman Oaks, CA 91403-2916

FAX (818) 325-8092 Heavenly Diet Store Mail-In or FAX Order Form

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Subtotal = _______

California. Residents add 5.00% sales tax = _______

U. S. Shipping & Handling (Please Call Store for Cost) = _______

International Shipping & Handling (50% of subtotal) = _______

APO & International Shipments must meet Minimum Order Amount of at least $100...............

Total Amount Due = _______

Ship to: _______________________________________________________ Address: ______________________________________________________ City:______________________ State: __________ Zip Code: __________ Country:______________________ Telephone: ____________________ If your payment is by credit card, please include card information below: We accept: VISA ___ MasterCard ___ American Express ___ Name on Card: _________________________________________ Card Number: ____________________________________ Card Expiration Date: ________ Mail orders to: Heavenly Diet Store 4621 Van Nuys Boulevard Sherman Oaks, CA 91403-2916 Fax: (818) 325-8092 Make checks payable to: Heavenly Diet Store FAX “credit card orders only” to (818) 325-8092. Telephone orders can not be accepted. A service charge of twenty five dollars ($25.00) will be made on checks returned for insufficient funds.