| Full Name:_____________________________________________________ |
| Street address :_________________________________________________ |
| ______________________________________________________________ |
| Phone:____________________ Fax: ____________________________ |
| E-mail:_________________________ |
| Becalmd Order: |
Retail: |
Quantity: |
| Neu-Becalm'd Chewable
-90 Tabs |
$35.50 |
______ |
| Neu-Becalm'd 90 Chewables
(4 Pack $31.50 per bottle) |
$126.00 |
______ |
| Neu-Becalm'd
90 Cap |
$37.50 |
______ |
| Neu-BeCalm'd 90 Cap
(4 Pack $33.25 per bottle) |
$133.00 |
______ |
| Neu-Relieve 90
Cap |
$34.00 |
______ |
| Relieve 90 Cap
(4 Pack $30.00 per bottle) |
$120.00 |
______ |
| Neu-Recover 90
Cap |
$37.50 |
______ |
| Neu-Recover 90 Cap
(4 Pack $33.25 per bottle) |
$133.00 |
______ |
| Neu-Replenish
90 Cap |
$37.50 |
______ |
| Neu-Repleni9sh 90 Cap
(4 Pack $33.25 per bottle) |
$133.00 |
______ |
| Neu-Slim -
90 Cap |
$38.50 |
______ |
| Neu-Slim 90 Cap
(4 Pack $34.25 per bottle) |
$137.00 |
______ |
| * Include
shipping and handling. |
S
& H |
______ |
| |
Total:
|
______ |
|
Shipping and Handling
Shipping will vary acccording to your zone. |
| 1-4 Bottles |
$8.50 |
| 5-8 Bottles |
$10.00 |
| 9-12 Bottles |
$13.75 |
|
Over 12 bottles or outside of USA shipping
prices will vary. |
|
|
All prices are in US dollars.
|
| Card Type:___________________________________ |
| Card Number:________________________________ |
| Expiration Date:___________ |
| Name on Card:__________________________________ |
| Message:________________________________________________________ |
| ________________________________________________________________ |
|