Please mail this completed form along with payment payable to:

Fitness and Kids
5529 Reef Rd.
Mentor on the Lake, Ohio   44060
Or Fax order to: 440-373-4669

http://www.fitnessandkids.com

Your Name: Last:
Delivery Address:                                                                       
Email:     
City:
State:                          
Zip Code:
Contact: Daytime Phone:

Item Number:

Name/Description:

Quantity:

Each:

TOTAL:
         
         
         
         

Name on Credit
card:_____________________________
Address:________________________________________
Credit card # ___________________________________ CVC code_______(3
digit code on back of card can not process without this
Expiration date:__________________________________
Subtotal S & H
$00.01 – $15.94 $0.00
$15.95 – $29.99 $5.50
$30.00 – $99.99 $7.50
$100 – $199.99 $17.50
$200 and Up $19.50
Subtotal of Order $_________________________
Shipping and handling $_________________________
TOTAL AMOUNT ENCLOSED $_________________________

*** Dance pads and Re-bounders have different shipping fees.  Please look at
the page on the site where these items are located and add appropriate shipping. 
If ordering re-bounder please state which videos you want with the re-bounder.