<< CLICK TO GO BACK TO "HOW TO ORDER"

Product Order Form

Print this Form and Fax or Mail to:

Healthy Source, LLC
19141 Stone Oak Pkwy., Ste. 104
San Antonio, Texas 78258

Customer Information:

Name:

Address:

City:

State, Zip:

Country:

Phone:

Email:

Your representative is: Linda Morris

Fax Orders:
1-800-997-8987 or +210-481-5662

Telephone:
1-877-352-8042 or +306-352-8042

Shipping Information:

Name:

Address:

City:

State, Zip:

Country:

Mix or Match with our Buy 3 or more Discount:

Qty.

Prod.
No.

Description

Sug.
Retail

Price ea. when you buy 1-2

Price ea. when you buy 3 +

TOTAL

3200

Flavay®

~~$59.95~~

$48.75

$44.50

3300

Flavay Plus®

~~$99.95~~

$78.00

$69.50

SHIPPING PRICE CHART
U.S.: Orders of $100 or more	. . . . . . FREE
U.S.: Priority Mail:	. . . . . . $6.50
U.S.: Express Mail:	. . . . . $27.00
CANADA: Priority Mail	. . . . . $19.50
CANADA: Express Mail:	. . . . . $30.00
INTERNATIONAL: Priority Mail	. . . . . $27.00
INTERNATIONAL: Express Mail	. . . . . $34.00
INTL & CANADA: 12+ Flavay Products	. . . . . . FREE

SUBTOTAL

SHIPPING: See Price Chart.

NOTE: International customers may be subject to customs fees and import duties. See customs information for more details.

TOTAL

Method of Payment:

Check or Money Order* /

Visa /

MasterCard /

Discover /

American Express
*Please make check or money order payable to: HEALTHY SOURCE LLC.

Credit Card No. :

Expiration Date :

Name on Card:

Card Holder's Signature :

AutoShip:	Select below to Join AutoShip and receive: (1) lower member pricing on your re-order and (2) convenient monthly or bi-monthly delivery:
MonthlyBi-Monthly1 (Jan-Mar-May-Jul-Sep-Nov)Bi-Monthly2 (Feb-Apr-Jun-Aug-Oct-Dec)

[Linda M.]

Effective Date: Jan 1, 2010

<< CLICK TO GO BACK TO "HOW TO ORDER"