Name:

        Company:

Street Address:

                 City:  ST: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY     Zip:

              Phone:   Fax: Email Address:

P/N        DESCRIPTION             QTY                    P/N        DESCRIPTION       QTY               

XER02    2lb Exercise Ball:                     XER04    4lb Exercise Ball:   

XER06    6lb Exercise Ball:                     XER08    8lb Exercise Ball:         

XER10    10lb Exercise Ball:                   XER12    12lb Exercise Ball:   

XER15    15lb Exercise Ball:                   XER16    16lb Exercise Ball: 

XER17    17lb Exercise Ball:                   XER18    18lb Exercise Ball: 

XER19    19lb Exercise Ball:                   XER20    20lb Exercise Ball: 

XER25    25lb Exercise Ball:                   XER30    30lb Exercise Ball: 

XER35   352lb Exercise Ball:                  XER40    40lb Exercise Ball: 

Thank you for your order