SHIPPING INFORMATION: |
| Name:___________________________________________ |
| Address:_________________________________________ |
_________________________________________________ |
| City:_____________________________________________ |
| State:__________________
Zip Code:________________ |
| Phone
Number:___________________________________ |
| E-mail:__________________________________________ |
CREDIT CARD INFORMATION: |
| Please circle credit card being used: |
| MC |
VISA |
Discover |
AMEX |
|
| CC#:____________________________________________ |
| Expiration
Date:__________________________________ |
| CVV2
Number (3 or 4 digit Card Verification Value located on back of card in signature block):
_________ |
Enter cardholder's address exactly as shown on credit card statement if
different from shipping address: |
| Name:___________________________________________ |
| Address:_________________________________________ |
_________________________________________________ |
| City:_____________________________________________ |
| State:__________________
ZipCode:_________________ |
_________________________________________________
Signature |
|
| PLEASE SEND THE FOLLOWING: |
Qty. |
Product Name |
Price |
Total |
____ |
CAPTRI MCT OIL 32 OZ. |
$40 |
________ |
| ____ |
MAX
ENDURANCE FORMULA |
$30 |
________ |
| ____ |
ENHANCED
GH FORMULA |
$36 |
________ |
| ____ |
ADVANCED
LIPOTROPIC FORMULA |
$28 |
________ |
| ____ |
LIVER-AMINO
FORMULA |
$34 |
________ |
| ____ |
ESSENTIAL
VITAMIN FORMULA |
$16 |
________ |
| ____ |
MINERAL
ELECTROLYTE FORMULA |
$12 |
________ |
| ____ |
MUSCLE
AMINO FORMULA |
$32 |
________ |
| ____ |
ULTIMATE AMINO FORMULA |
$34 |
________ |
| ____ |
CREATINE MONOHYDRATE 300 GRAM |
$29 |
________ |
| ____ |
EVENING PRIMROSE OIL |
$24.95 |
________ |
| ____ |
JOINT FORMULA |
$20 |
________ |
| ____ |
PRO CARB POWDER 35oz CHOCOLATE OR VANILLA FLAVOR |
$24 |
________ |
| ____ |
HI PROTEIN POWDER CHOC OR VANILLA
FLAVOR |
$36 |
________ |
| ____ |
OPTIMIZED WHEY PROTEIN
POWDER CHOCOLATE MALT, VANILLA MALT OR
STRAWBERRY MALT |
$40 |
________ |
| ____ |
50/50 + MEAL SUPPLEMENT
POWDER CHOCOLATE, VANILLA, ORANGE CREAM AND MILK
FLAVOR |
$32 |
________ |
| ____ |
HIGH PROTEIN/LOW CARB
PUDDING CHOCOLATE, BANANA, VANILLA AND
BUTTERSCOTCH |
$24.95 |
________ |
| ____ |
PARRILLO ENERGY BARS
12 PER BOX QUANTITIES ONLY - CHERRY
CORDIAL, CHOCOLATE ALMOND COCONUT, FRENCH VANILLA, FRENCH TOAST, GRAHAM CRACKER, PEANUT
BUTTER SUPREME, AND SWEET MILK CHOCOLATE |
$24 |
________ |
| ____ |
PARRILLO PROTEIN BARS 12 PER BOX QUANTITIES ONLY - BANANA, FUDGE BROWNIE, PEANUT
BUTTER DELIGHT, PINEAPPLE, STRAWBERRY SHORTCAKE, VANILLA CRÈME AND LAYERED PEANUT
BUTTER/BANANA |
$27 |
________ |
|
|
Total: |
________ |
|