ORDER FORM

Item No.

Quantity

Title

Color

Size

Price

   
  BBEV1   "Original" Buddy Belt  BLK - RED S - M - L $49.95  
  BBEV2   "Cruiser" Buddy Belt   BLK S - M - L $69.95  
  BBEV3   "Combo" Belt  (removable pad)   BLK S - M - L $74.95   
  BBEEADJ   Extension - adj  7 1/2" - 10 1/2"  BLK - RED

N/A

 $4.95  
  BBEEFIX   Extension - fixed 5 1/2" BLK - RED N/A $3.50  

  PLEASE INDICATE WAIST SIZE OF USER  ___________________                                               Subtotal 

  

ship to:              Please print  clearly           ( P.O. boxes accepted)
Name __________________________________________________
Company _______________________________________________
Street __________________________________________________
City ___________________________________________________
State/Prov__________________________  Zip/Postal ____________
Country___________________
Contact Telephone  (            ) _______________________________

Make checks or money orders payable to Buddy Belt Enterprises, Inc.

Credit Card Information:
                     [ ] Visa    [ ] Mastercard     [ ]  Discover

Account No. ___________________________________________
Exp. Date ______________

Print Cardholder Name ____________________________________
Card holder’s billing address if different than shipping address: 
Street ________________________________________________
City __________________________________________________
State/Prov___________________________ Zip/Postal _________

To place your order after completing the form:    AMA # ______________
CALL or MAIL or FAX the form to the address to the right.
                            E-mail sales@buddybelt.com
To better serve our customers please indicate below where you heard about us.   Circle one or more.

 Discounts

   
New Jersey Residents
Add 7% sales tax 		 

Shipping  (see below)  

 

    TOTAL

 
  Shipping Information

Order Amount      U.S. Charges 
1 Belt              $5.30
2 or more Belts        Please Call

       
Next Day Express      $21.40          
            COD               $6.25 extra 

Canadian Customers
Please call, fax or Email for
special pricing in Canadian $

Buddy Belt Enterprises, Inc.
362 Flocktown Road
Long Valley, NJ 07853
Tel: (908) 850-0612
Fax: (908) 850-1391
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