DIRECTIONS: Print out the form using your browser. Circle the quantity of bottles you wish to order, then complete the address section before mailing or faxing the form to us.
60 capsules/ bottle Take 1 to 3 caps per day |
|||
QUANTITY |
PRICE |
SHIPPING/ HANDLING |
TOTAL - U.S. $ |
1 |
$ 16.00 |
$ 3.00 |
$ 19.00 |
2 |
$ 32.00 |
$ 4.00 |
$ 36.00 |
3 |
$ 48.00 |
$ 4.00 |
$ 52.00 |
4 |
$ 64.00 |
$ 6.00 |
$ 70.00 |
6 |
$ 96.00 |
$ 8.00 |
$ 104.00 |
8 |
$ 128.00 |
$ 9.00 |
$ 137.00 |
12 |
$ 192.00 |
Free!! |
$ 192.00 |
Name____________________________________ Phone ( ) _______________
Mailing Address_________________________________________________________
_____________________________________________________________________
City______________________________ State______ Zip _______________________
E-Mail________________________________________________________________
PAYMENT METHOD: (check one):
Check _______ Money Order ________
Card Number:_________________________________________
EXP. DATE _______________________ Discover _____ MasterCard_____ Visa _____