ORDER FORM

ORDER FORM - PLEASE PRINT

HSIN TEN ENTERPRISE CANADA INC.
20 Wertheim Court, Unit 32
Richmond Hill, Ontario L4B 3A8, Canada
Order Tel: 1 (866) 483-8888
Fax: 1 (866) 483-8880

For Office Use Only: Assigned ID No.: A___________     Other:_____________

Sponsor's Information: Jonny Chevalier Distr. No. A201960

Today's Date __________________________

First Name: ____________________

Last Name: _____________________________

Street Address: ________________________________________________

City: ______________ County__________ Stat/Pprov.: ____

Zip/Postal Code: _____

Country: ___________

Daytime Telephone No.:___________________

Payment Method (Please circle one): Visa / MasterCard / AmEx / Discover

Credit Card Information: Card No.: __________________________________________

Card Holder's Name: ______________________Exp. Date: __________

Signature: _____________________________________________________

Product Description Part #
Unit Cost
CDN $'s
Qty
Ordered
Extended
Cost

The Original Chi Machine SM-330, 110V USA/Mexicao/Canada Model SS001C2
$720.00


The Original Chi Machine SM-330, 220V/50Hz European Model SS001A6
$720.00


Chi Machine - 110V/50Hz Foreign Model SS001A2 $720.00

Hothouse YS-50 110v SY010A2

$1,349.00



Hothouse YS-50 220v 6022

$1,349.00



Fir-To-Go 110v SY020A2
$599.00


Electro Reflex Energizer - 110v SR001A2
$524.00


Chi Machine Carrying Bag ASS001001
$45.00


HotHouse Carry Bag ASY010001
$90.00



Distributor's Sales Kit ABA001002
$59.99



Shipping is Free in the Continental US & Canada for orders over $300


Local Sales Tax (GST & PST)


* Within the Continental US, freight charge will be calculated as follow: If total order of products and promotional materials is more than 300.00, the freight will be free of charge; otherwise, the freight charge will be 5% of total order of products with a minimum of 4.00. Freight may be taxable based on state regulation and Ship to Address. ** The Tax rates are based on state regulation and Ship to Address. *** Restocking fee: The person who place the order will be responsible for a restocking fee - 5% of the order price if the order is returned to the company in any of following conditions: (i) the receiver refused to accept the order. (ii) UPS is unable to reach the receiver after 3 trial deliveries. For tax exempt sales please call customer service. Grand Total