Purchase Order Form

* NOTE* Please fill in the following order form. Click on Total Order than print this form twice. Keep one copy for your records and mail in the other along with your check or money order made out to: 

AJ Health & Fitness
1003 Alpen Strasse Drive
Latrobe, PA 15650

# Fields must be filled up for submission 

First Name       # 
Last Name       # 
Email Address  
Address Line 1# 
Address Line 2   
City                   #
State Zip # 
Daytime Phone
Simple Order Form
Item Name Qty @Price SubTotal
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@
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Sales Tax: Sales Tax is included.  
Shipping&Handling: Shipping is always FREE!    
TOTAL: