Dynamax Medicine Ball Order Form

for Mailing or Faxing

Print this page, fill it out, and EITHER mail it or fax it to us.

MAILING Instructions: Send form with payment to:

Dynamax Incorporated

805 South Turnerville Road

Buda, Texas 78610

FAXING Instructions: FAX to (512) 447-4427.

Upon receipt of payment, we’ll get your order shipped to you immediately!

Date	___/___/______
Last Name	___________________	First Name	____________________		Middle Ini.	_______
Address	___________________________________________________________________________
City	___________________	State	____________________		Zip Code	_______
Phone	(_____) _____-______	Email Address (optional)		_______________________________

Form of Payment (Circle one): Check/Money Order Credit Card (Must fill out following:)

Credit Card Type (Circle One): Visa MasterCard American Express

Credit Card # _________________________________________ Expiration Date: ___/___/______

Signature: _________________________________________

Quantity	Color Number	Description	Unit Price	Line Total
		4 lb Stinger 1	$74.95
		6 lb Stinger 2	$79.95
		8 lb Accelerator 1	$84.95
		10 lb Accelerator 2	$89.95
		12 lb Stout 1	$94.95
		14 lb Stout 2	$99.95
		16 lb Hefty 1	$104.95
		18 lb Hefty 2	$109.95
		20 lb Burly	$114.95
		Dynamax Bat (3 lb)	$19.95
		Carrier/Throwing Sling (1 lb)	$19.95
		3-Ball Carrier (3 lb)	$39.95
		Subtract $5 for each Black & Grey ball	- $5.00
			SUBTOTAL
		Texas Residents Only – TAX	8.25% of Subtotal
		Shipping & Handling – Visit
		www.medicineballs.com/shipping
		to calculate your shipping expense.
			Total