Mail / Fax Order Form
 *Print this page, fill out all information, and send this form by mail or fax to:
Prime Life Nutriceuticals / HoodiSpray
5390 Overpass Rd Ste B
Santa Barbara, CA 93111

FAX: 805-681-8201

1.

Customer Information

Name:

Address:

City:

State:

 Zip:

Country:

Phone:

Email:
 

2.

Payment Method

Select one

Money Order / Cashiers Check (Payable to Prime Life Nutriceuticals in US$ only)

Visa / MasterCard / American Express (circle one)

Credit Card Number:

Expiration Date:

/  Signature: _________________________

3.

Select Products

Buy 2 bottles of HoodiSpray™ Get 1 bottle Free
(Three Month Supply )

$99.85 $79.90

Buy 3 bottles of HoodiSpray Get 2 bottle Free
(five Month Supply )

$199.75 $119.85

Buy 5 bottles of HoodiSpray Get 4 bottle Free
(nine Month Supply )

$359.55 $199.75

Single bottle of HoodiSpray

$49.95  $39.95

Special Bonus Offer: Detoxify
Advanced Cleansing & Weight Loss Formula
(30-Day Supply)

$39.95 $29.95
 

Subtotal:

$.

Shipping :
We accept US orders only

$9.95

Grand Total:

$.

4.

Mail Order Form to: (Make a check payable to Prime Life Nutirceuticals)

Prime Life Nutriceuticals / HoodiSpray
5390 Overpass Rd Ste B
Santa Barbara, CA 93111

or Fax This Form to:

805-681-8201

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