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Shipping Information:

Name:
 ________________________________________________________
Address:
 ________________________________________________________
City, Province/State,
Postal Code & Zip:
 ________________________________________________________
Phone:
 ________________________________________________________
In what magazine did you see our advertising? :
 ________________________________________________________
* (International Orders Only)
Email for Tracking:
 ________________________________________________________

Order Information:

Order Type
Quantity
Price
Shipping
Total
3 Month Supply
3
$149.95 USD
included
$149.95 USD

   For Double order (6 mos) discount - USA $259.95 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:

BIE Health
3840 East Robinson Rd., Box 139
Amherst, N.Y., 14228
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.

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Copyright © 2000 BIE Health.