GHR Six Month Supply

BIEHealth
Name:
________________________________________________________
Street Address:
________________________________________________________

City, Province/State, Postal Code/Zip:

________________________________________________________
Phone:
________________________________________________________
In what magazine did you see our advertising? :
________________________________________________________

Email for Tracking (Int’l Orders Only):

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Order Information:

Order Type
Quantity
Price
Shipping
Total
6 Month Supply
6
$259.95 USD
included
$259.95 USD

For Double order (12 mos) discount – USA $479.80 USD

For larger order discounts, call operator.

For orders outside of North America, add $40 shipping.
* For orders outside of North America, we will email tracking number.

Payment Information:

OPTION 1 >> Paid in full ( 1-time payment )
[ ] Visa [ ] Mastercard [ ] Discover

Card Number _______________________________ Expiration Date _______
Signature __________________________________


OPTION 2 >> Payment Plan ( 3 equal monthly payments *NO INTEREST* )
[ ] Visa [ ] Mastercard [ ] Discover

Card Number _______________________________ Expiration Date _______
Signature __________________________________

Mail or Fax to:
BIEHealth, 812 Proctor Avenue, Ogdensburg, NY 13669
Fax Number: (905) 639-0957

Orders are shipped the day after they are placed, via Postal Mail. Please allow at least 7 days for delivery.