Order Form

FAX or Mail-In ORDER FORM
Print Form out First.
Send all requests to:
Dynamic Fitness
3236 W. Sepulveda Blvd. #C
Torrance, CA. 90505
1-800-451-7274
Fax: 1-310-517-9608
Email: Jump Boots

BILLING NAME:
DATE:
ADDRESS:
PO#:
CITY:
STATE:
ZIP CODE:
BUYER TEL:
BUYER FAX:
SHIP VIA:
Visa :Master Card: American Express
CC#:
CARD EXPIRATION DATE:
E-Mail:

Product Name	Shoe Size	Your Weight (lbs)	Male or Female	*Cost*
1)
2)
Shipping/Handling (International Orders $25.00)
TOTAL

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Dynamic Fitness
3236 W. Sepulveda Blvd. #C
Torrance, CA. 90505
1-800-451-7274
Fax: 1-310-517-9608
Email: Jump Boots

* Notice: Orders processed through unsecured e-mail. Submit at your own risk.
** If you would like, you may print this blank form, fill it in, and fax it to 1-310-517-9608, or mail it tothe above address