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Mail-In or Faxed Order Form |
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Mail-In or Faxed Order Form |
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| Bill To: | Ship To: If same as Bill To leave blank | ||||
| *Name: | *Name: | ||||
| *Address: | *Address: | ||||
| *City: | *State: |
*Postal Code: |
*City: | *State: | *Postal Code: |
| *Day Phone: | *Day Phone: | ||||
| *E-Mail: | *E-Mail: | ||||
| Yes! I want to take advantage of your reseller program -please contact me. Please send your free catalog of vitamins & herbs |
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Quan.
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Item #
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Description
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Unit Price
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Total
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IGM36 |
Imperial Gold Maca™ Single Bottle 36 Capsules Trial Size 600mg |
$10.89 |
$ |
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| IGMC1 | Imperial Gold Maca™ Single Bottle 100 Capsules 600mg |
$19.89 |
$ |
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| IGMC-3 | Imperial Gold Maca™ 3 Bottle Special Total 300 Capsules 550mg | $56.85 |
$ |
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| IGMC-6 | Imperial Gold Maca™ 6 Bottle Special Total 600 Capsules 550mg | $99.00 |
$ |
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| IGMC-12 | Imperial Gold Maca™ 12 Bottle Special Total 1200 Capsules 600mg | $149.00 |
$ |
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| IGMPB4 | Imperial Gold Maca™ Bulk Powder 4.0.oz - 113gr ¼ Pound Bag | $19.88 |
$ |
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| IGMPB8 | Imperial Gold Maca™ Bulk Powder 7.5 .oz - 212gr Almost A Full ½ Pound | $28.89 |
$ |
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| IGMPB1K | Imperial Gold Maca™ Bulk Powder 1 Kilo - 2.2 Pound | $79.90 |
$ |
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| IGMPB5K | Imperial Gold Maca™ Bulk Powder 5 Kilo -11.25 Pounds $15.91LB | $349.00 |
$ |
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| IGMPB10K | Imperial Gold Maca™ Bulk Powder 10 Kilo -22.5 Pounds $13.29LB | $569.00 |
$ |
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| GIGM-1 | Gelatinized Imperial Gold Maca™ Single Bottle 100 Capsules 600mg | $29.88 |
$ |
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| GIGM-3 | Gelatinized Imperial Gold Maca™ 3 Bottle Special 300 Capsules 600mg | $85.89 |
$ |
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| GIGM-6 | Gelatinized Imperial Gold Maca™ 6 Bottle Special 600 Capsules 600mg | $159.00 |
$ |
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| GIGM-12 | Gelatinized Imperial Gold Maca™ 12 Bottle Special 1200 Capsules 600mg | $249.00 |
$ |
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| GIGM1K | Gelatinized Imperial Gold Maca™ Bulk Powder 1 Kilo - 2.2 Pound | $119.00 |
$ |
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| GIGM5K | Gelatinized Imperial Gold Maca™ Bulk Powder 5 Kilo - 11¼ Pounds | 449.50 |
$ |
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| ooo1 | Royal Oil of Oregano™ - Helps Kills Bacteria, Fungus and Parasites Fast! | $34.89 |
$ |
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| REI1 | Royal Energized Iodine™ - May Help To Regulate The Thyroid and Other Glands Effectively. | 24.89 |
$ |
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| LIST ADDITIONAL ITEMS BELOW NOT LISTED HERE | ||||
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*Prices shown are for mail order or fax orders only |
Subtotal |
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*Shipping |
$ |
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REMARKS: |
Amount Due |
$ |
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Mail Orders may be paid for by Check, Money Order, Cashiers Check, Credit Card. Make Checks payable to A Healthy
Alternative, LLC. A Healthy Alternative, LLC. |
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Faxed Orders may be
paid for by Credit Card only. Fax Order form with credit card
information and signature to the number below. Orders Are
Processed Within 24-48 Hours. Mailed Orders with money orders are
shipped at once. |
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