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Simply complete and mail this form to our office with your payment or payment information. Once received and successfully processed, we will be in contact with you to provide your purchased product.
*All fields required
Complete Name:
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| Payment Method (circle one): Check or M/O Visa Mastercard Discover Am. Express |
| Quantity (circle one): 1 Month Supply: $54.95 2 Month Supply: $99.95 (almost 10% savings!) |
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Signature:
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By signing above, I authorize Healthy Hearts Club to charge my Credit Card for the above purchase price of Heart and Body Extract, plus $5.00 shipping/handling. |
