Order Form

Name: ___________________________
Shipping Address:
Address: ___________________________
City, State, ZIP ___________________________
Phone Number: ___________________________
E-mail Address: ___________________________

Billing Address:  (If different from shipping address)
Name: ___________________________
Address: ___________________________
City, State, ZIP ___________________________

Stock Number Description Quantity Unit Price Total Price
         
         
         
         
         
         
         
         
         
Sub Total:  
If Sub Total is $40 or more, check this box if you would like free NSP membership:   
Shipping/Handling ($6.50 for orders under $100, $8.50 for orders of $100 or more):  
Add sales tax for orders in CA, MA, OK, KS, UT, or WI:  
Total Price:  

Payment Information: 
___ Credit Card      ___ Personal Check      ___ Money Order

Credit Card Information: ___Visa   ___MC   ___AMEX   ___Discover 

Credit Card Number:______________________________________________ Exp. Date: _______


Please mail this form to: 
Healthy Sunshine, Inc.
506 Ivy Lake Road, Morrison, TN 37357

Fax orders to:  931-728-7145

Please make any checks payable to Healthy Sunshine, Inc.
If you have questions, call us toll free at 1-888-523-1727.