| Stock
No. |
Product
Description |
Qty |
Retail
Price |
Dist
Price |
total |
| 9805 |
Ultimate Aloe Capsules (90Caps) |
|
$72 |
$52 |
|
| 9704 |
Maximum Colon Cleanse (60Caps) |
|
$50 |
$30 |
|
| 9707 |
Ultimate Anti-Oxidant
(60 ct) |
|
$56 |
$36 |
|
| 9803 |
Ultimate Enzymes (270 Caps) |
|
$80 |
$45 |
|
| 9703 |
Ultimate Glucosamine
(90 Caps) |
|
$50 |
$30 |
|
| ORDER TOTAL |
|
|
| Payment
Method |
| Charge Card |
 Visa |
Mastercard |
Discover |
AMEX |
| Credit Card No. |
|
| Expiration date |
|
| Name on card |
|
| Signature |
|
| Authorization |
| |
| Bank Draft |
| PLEASE ENCLOSE VOIDED
CHECK |
| Bank Name |
|
| Bank Address |
|
| 9
digit routing # |
|
| Account # |
|
| Fraction code |
|
| Signature |
| |
Shipping
Methods:
DHL
$7.50 for 1 bottle
$.50 for each additional bottle.
| |
| Product Total |
|
|
|
Shipping/Handling
DHL
Other |
|
| Date Order
Received |
|
| Order
# |
|
|
|
|
|
|
| |
| Email for all countries outside Continental USA or for Overnight & special
deliveries are per quote!
| |
| Distributor Name: |
Jim & Dee Patrick |
HN #: |
# 3333
|
| SHIP TO: |
| Name
|
| Address
|
| City
|
| State
Zip
|
| Telephone (
)
| | | |
