Cholesterclear™
Mail Order Form
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Please print and fill out this form completely and mail it with your money order or bank draft in US dollars to:

URBAN NUTRITION
PO Box 3087
Hoboken, NJ 07030
USA		 Please note: We accept money orders (US dollars) only. Sorry, we do not accept cash, personal checks, electronic checks, PayPal or COD orders.
 
4 MONTH SUPPLY Cholesterclear x 4 boxes - SAVE $50 $144.96
 
3 MONTH SUPPLY Cholesterclear x 3 boxes - SAVE $30 $119.97
 
2 MONTH SUPPLY Cholesterclear x 2 boxes - SAVE $10 $89.98
 
1 MONTH SUPPLY Cholesterclear x 1 box $49.95
 
SPECIAL OFFER: Order any of the above and get 1 Longevity for only $29.99 – SAVE $20 $29.99
Shipping Information:
Name:
  
Address:
  
City/State/Zip:
  
Telephone:
  
Email Address:
  
Amount Enclosed:
Write in the amount for the Cholesterclear supply you chose:
 $
Would you like to add 1 or more Longevity?
Quantity (    ) X $29.99 =
$
Shipping and Handling:
 $
TOTAL ORDER IN US DOLLARS:
 $