Cures 4 You Logo Fax/Mail Order Form
We accept Visa / Mastercard, Check or Money Order
 
Item   Price US$: Qty: Subtotal: 
Brazil Live Coral™ - 120 Capsules     
1 to 5 bottles   24.95 X = $
6 to 11 bottles   22.95 X = $
12 or more bottles   19.95 X = $
Health Machine's Greens with MSM™ - 180 Capsules     
1 to 11 bottles   13.50 X = $
12 to 23 bottles   12.50 X = $
24 or more bottles   11.50 X = $
The Kitchen Sink™ - 180 Capsules     
1 bottle   $44.95 X = $
2 to 5 bottles   $39.95 X = $
6 to 11 bottles   $32.95 X = $
12 or more bottles   $29.95 X = $
  1 Subtotal   $
2 Shipping
3 Total Payable Add lines 1 & 2  $
Billing Address
Your Credit Card can only be processed if correct address and phone number that your credit card is registered to is supplied.  
Name:
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Email:
 (for order confirmation)
Credit Card Information
Credit Card:          Visa MasterCard
Card #:
Card Expiry:                     Month:  Year: CVV2# :
Name:
 (as shown on card)
Shipping Address (Only if different then your Billing Address)
Address:
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Phone #:
 
Mail Order Form with payment to
HL Distribution Call Center, #2805-1323 Homer St. (Buzzer 335) Vancouver, BC V6B 5T1 Canada
or by Fax to 604-899-4572