| Ship-To Name | Enter Today's Date: ________/________/________ |
| Address | E-Mail Address (used to send order confirmation and receipt) |
| City | Phone Number (used only in case of delivery problems) |
| State Zip | ( ) |
| Product Name | Quantity | Price Each | Line Total |
| Free Wellness Kit - A $69.99 Value - Absolutely Free! | 1* | 0.00 | 0.00 |
|
*There's no limit on the number of Free Wellness Kits you can order. Just photocopy this form and use as many times as you would like. Sorry - no personal checks can be accepted for payment. |
A. Subtotal | $ 0.00 | |
|
Payment:
[ ] Money Order/Cashiers Check (Payable to: ISC Wellness Co.) [ ] VISA [ ] MasterCard [ ] American Express [ ] Discover Card Credit Card No. _____________________________________________________ Expire Date ______________ Signature _________________________________ Card Billing Address (if different from Ship-To Name & Address above): Name ____________________________________________________________ Address ___________________________________________________________ City __________________________ State _____________ Zip ______________ IMPORTANT: Billing address must exactly match the credit card statement address. |
B.
Shipping & Handling ($9.95 per kit ordered) |
+ $ 9.95 | |
|
C.
Final Total (Amount due in full.) |
= $ 9.95 | ||
| Natural Health and Wellness Product Selections: Your Free Wellness Kit comes with a sampling of natural health and wellness products. You get your choice of products in three categories: Weight Loss Products, Nutritional Supplements, and Digestive Health Supplements (choose below). This is a great way to explore high-quality natural health and wellness products! | ||
|
Weight Loss: (Choose only one below:) [ ] Carb Blockers [ ] Fat Blockers |
Nutrition: (Choose only one below:) [ ] Multiple Vitamin/Mineral [ ] Stress Relief Formula |
Digestive Health: (Choose only one below:) [ ] Stomach/Indigestion [ ] Colon/Constipation |