Order by Phone: (805)-650-3303 or toll free (888)-388-9898
Order by Fax: (805)-650-1689
To order by mail, send your completed order form and payment to:
P. O. Box 3395, Ventura, CA 93006-3395 USA

email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it   www.braingym.com

Our business hours: Monday through Friday, 9:00 am to 5:00 pm (Pacific Standard Time)

Order Date:______________________

BILLING ADDRESS:
_________________________________
Name(Please Print)
_________________________________
Street Address
(UPS orders CANNOT be delivered to P O Boxes)
_________________________________
City, State, Zip Code, Country
_________________________________
Daytime Phone

Is this your first order with us? yes no

SHIP TO ADDRESS: (If different from billing)
_________________________________
Name (Please Print)
_________________________________
Street Address
(UPS orders CANNOT be delivered to P O Boxes)
_________________________________
City, State, Zip Code, Country