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Please
print and fill out this form completely and fax it to: (201) 876-2501
| Please
note: We accept money orders (US dollars) only. Sorry, we do
not accept cash, personal checks, electronic checks, PayPal or COD
orders. |
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| |
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 |
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Shipping
Information:
Name: |
|
Address: |
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City/State/Zip: |
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Country: |
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Telephone: |
|
Email
Address: |
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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: |
$ |
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|
Amount Enclosed
Type
of Credit Card: |
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Visa |
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Mastercard |
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Discover |
|
American
Express |
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Credit
Card Number: |
|
Expiration
Date: |
_______Month
_______Year |
Security
Code:
(3 or 4 digit number on back of card) |
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Signature: |
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