COMPU-CAL ORDER FORM

You can also use this form to order Nutrtition Assistant software and upgrades.
To send your order request, fill in the blanks below, and
click the "Click ONCE...." button at the bottom of the form
or print it out, fill it in, and fax it to 360-352-3472.

X	ShipTo:
Name or Attn.:
Organization:
Address1:
Address2:
City:
State:	Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Out of USA
Zipcode:
Country (opt):
Phone1:
Phone2:
Fax:
Email:
Qty of Nutrition Asst at Intro price $199:
Qty of Upgrades at $79:
Other: specify here Or in msg box:
Other: specify here Or in msg box:
Shipping(N/C for Priority Mail):
Credit Card type (Visa, MC, AE, Discovery:
Person Name on Credit Card:
Credit Card Number:
Credit Card Expiration Date:

Message (optional):

  
   © 2007 Compu-Cal Inc.• 9545 Delphi Rd SW • Olympia WA 98512 •  360/352-5038 • Email: support@compu-cal.com a