Your Name:______________________________________________________

Name of your team or school: _________________________________

Address: ____________________________________________________________________

____________________________________________________________________________

Phone (____)___________ 2nd phone: (____)____________ E-mail _____________ 

Where will the products be shipped? ______________________________________________ 

Product                        Number            Tax            Shipping            Total

PowerCam                   ______             ____          _______            ______                 

Power Tower               ______             ____          _______            ______

Power Rack                 ______             ____          _______            ______

Power Sketch              ______             ____          _______            ______

Power Reel                  ______             ____          _______            ______

Grand Total                 ______             ____          _______            ______

Total:  _________  Add State Tax: ______ Total __________ Check # _______________

Visa  1  MC  1   Number ____________________________ Exp: ___________CVV ______

P.O. Number _____________________________

Thank you.  It’s our greatest joy and honor to support your goals.  Please fax or mail this form today while your stories are fresh on your mind.

FAX to (419)526-0291

OR SEND THIS FORM TO Total Performance Products

777 Cypress Drive, Mansfield, Ohio  44903

Toll Free Phone Number: (800) 913-7946

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