| Bill To Address | Ship To Address (if different from billing address) | ||
| Name | Name | ||
| Address | Address | ||
| City, State, Zip | City, State, Zip | ||
| Phone | |||
| Special Limited Time Offer!! Take advantage of this special offer for Mother Nature's Miracle™ | ||||
| Order one 32oz. bottle a $79.00 value for only $50.00 + $11.00 shipping. |
Order Two 32oz. bottles of Mother Nature's Miracle™ for $100.00 + $14.00 shipping and get a THIRD BOTTLE FREE! |
Order Four 32oz. bottles of Mother Nature's Miracle™ for $200.00 + $22.00 shipping and get TWO BOTTLES FREE! |
Mother Nature's Order one 32oz. bottle for only $50.00 + $11.00 shipping. |
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Order Two 32oz. bottles of Mother Nature's Triple Arthojointflex™ for $100.00 + $14.00 shipping and get a THIRD BOTTLE FREE! | ||
| Outside US add $26.00 shipping for all products | Outside US add $43.00 shipping for all products |
4 Bottle case not shipped outside US Including Mother Nature's Triple Arthojointflex™ | Order Four 32oz. bottles of Mother Nature's Triple Arthojointflex™ for $200.00 + $22.00 shipping and get TWO BOTTLES FREE! |
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| Qty | Product Name | Shipping and Handling |
Price | Total |
| 1 | (example) Mother Nature's Miracle 32 oz. | $11.00 | $50.00 | $61.00 |
| Total Amount |
| Method of Payment (circle one) | Print this form, fill in your address and payment information, and send the completed form to us by Mail: Gordon E Gainey Please make checks payable to: |
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| Check - Money Order - Visa - Master Card | ||
| Card Number | ||
| 3-Digit Security Code | ||
| Exp Date | ||
| Cardholder's Signature | ||
| Gordon E Gainey Independent Distributor, 3644 Meadowview Road, Kershaw, S.C. 29067 Phone: 803-475-5948 |
| Return To Mother Nature's Miracle |