Application may be made by phone, fax, or E-mail
115 West Pacific Avenue * Spokane, WA  99201
Phone & Fax:  (509) 363-1353
info@robertkarl.com

Health Club
You must be 21 or older to join.

Shipping Address:

NAME______________________________________________

ADDRESS___________________________________________

ADDRESS___________________________________________

CITY________________________ STATE______ ZIP________

PHONE_____________________________________________

EMAIL_____________________________________________

Payment Information:      VISA______    MasterCard______

Card #___________________________________________________

Exp. Date___________________

Billing Address (if different):

NAME______________________________________________

ADDRESS___________________________________________

ADDRESS___________________________________________

CITY_______________________ STATE______ ZIP_________

2 Bottles____ 4 Bottles____ 6 Bottles____ 12 Bottles____

Your credit card will be billed for the wine and shipping
at the time of shipment. 
Your membership may be canceled at any time prior to shipment.

Health Club
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