Scrambled Coder--

Vitality Order Form for USA and Canada Only

Personal Information
Email Address:
Your Name:
Address:
City, State  Zip: , 
Phone:
Order Information
  Qty. Unit Price Total
Progesterone -Balance Cream#135 17.20 US
New Generation Vitamins #1001 19.20 US
Noni in Pill Form 400mg Per
Capsule #150		 40.00 US
OPC 2000 with Reservatrol #103 23.95 US
New Energy #3025 11.45 US
Complete Balance Program 
Kit #200		 45.00 US
Formula AD - High Stress #3016 16.95 US
Calorie Shield -180 Caps #6302 29.95 US
St.John's Wort #3039 
Depression		 18.95 US
Immunazyme -#3038  22.75 US
Odorless Garlic 90 Caps - #5006 4.80 US
Herbal Combination 8 
Sugar Balancer #4008		 7.00 US
Lecithin -200 Caps #2016 9.65 US
Gotu Kola - Memory Enhancer #5008   6.15 US
Herb Combo 6 - Edema #4006 6.25 US
Vitamin C 500mgs 120caps #2009   7.90 US
GINGAZYME - Ginko Biloba #3036 16.80 US
HERS Natural Viagra for Her - #3045 16.95 US
Enhance Azyme- #3040
31.25 US
   Subtotal
    $4.00 shipping/handling (free if over $50 in purchases)
    Nevada Sales Tax add in -
    I AM a Nevada Resident
    SSI or Tax No.
Order Total
Credit Card Information
Card Type:
Card No:
Expiration Date (mm/dd):
Name Appearing on Card:

If you would like to order anything not on this list - DO EMAIL me
and tell me what it is that you would like and I will add it to your order!
Aging Cream is $27.00   -- Beta Immune Blocker is $ 65.00
This order form automatically gives you the wholesale prices and
allows you to be an Independent Distributor for Vitality Life Choice

Remember this is a USA and Canada Only Company
If you are elsewhere in the world, please email me, and I will
help get you to a company that is international with quality products.

Shipping and Handling are Free on a $50.00 or higher order -)

Welcome to Vitality Life Choice.  You will soon have
your own ID number and a Free Packet from the company.
And, then you will be able to order from the privacy from your own home.

Any Questions or Problems? Do e-mail me below
 
 

 Back To Product Page

 E-mail