Purchase Agreement / Order Form

 

InnerSense, Inc.

2118 Wilshire Boulevard #730

Santa Monica, California 90403

(310) 828-7714 Voice (310) 829-9784 Fax

 

Date:

 

Customer:
Address:
Phone:		FAX:

 

_________ITEM DESCRIPTION__________UNITS EACH__________PRICE__________TOTAL COST

 

 

 

 

 

 

                     

 

Shipping (Next Day)                                                                                                                           

Sales Tax              

TOTAL SALE

                                                                                                                               

Charge Authorization:  (customer  to fill in)

Credit Card Type (circle one):       

Card Number: 

Exp. Date:

Name as shown on card:

Address Associated with card account (if different than above):

Customer here by authorizes InnerSense, Inc. to charge the "Total Sale" amount as indicated on this form. 

InnerSense, Inc. accepts no returns on these items.  Credit is limited to repair or replacement of damaged

merchandise only.  Call for return authorizations for damaged goods.  All products are warranted for a period

of one year from purchase. 

 

Accepted by (customer signature):       _________________________________Date:    ______________

 

Customer:  Please fill in, sign, and fax this form to (310) 829-9784 or mail to the above address.  Thank You!