Total Health Discount Vitamins 
120 Broadhollow Rd Suite 1, Farmingdale, NY  11735
1-800-283-2833; 631-293-3001 fax 631-293-3009
www.totaldiscountvitamins.com
Credit Card Authorization

Thank you for your purchase from Total Health Discount Vitamins. For your protection, we ask you give 
authorization to charge your credit card.
 
Please read and fill out the form completely.   
 
Cardholders Signature: _______________________________________________ I, 
_________________________________Print Cardholders Name, authorize Total Health Network to 
charge my credit card for the following internet sale:

Type of Card:______________________________

Credit Card #_______________________________   Exp. Date ______________

Date of Order:____________  Amount**:______________ Order#____________
 
Billing Address: _________________________________________________________________

______________________________________________________________________________

City, State, and Postal code: _______________________________________________
 
Country:________________________ Telephone Number:________________________ 

Ship to Address(if different than Bill to Address):__________________________________ 

______________________________________________________________________________


Please include a copy of your credit card.

Please print, fill out and send this form back to Total Health Network 
by fax at 631-293-3009 or by mail to: Total Health, 120 Broadhollow Rd Suite 1, Farmingdale, NY 11735 

Please check with your country's customs office regarding the import of 
our products. The buyer is responsible for any import restrictions, 
prohibited import items, taxes, tariffs, fees, duties etc. Total Health 
cannot accept responsibility for any International orders once they have 
left the United States. The buyer accepts all risks of delivery, and additional shipping fees.

**Plus Additional Postage will be added, based on final packed weight 
of your package to your country. Please check our website for International/shipping fees and information.