Mail / Fax Order Form
 *Print this page, fill out all information, and send this form by mail or fax to:
Prime Life Nutriceuticals / HoodiThin
165 Castilian Dr
Goleta, CA  93117

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 HoodiThin Get 1 bottle Free

$119.90

Buy 3 bottles of HoodiThin Get 2 bottle Free

$179.85

Buy 5 bottles of HoodiThin Get 4 bottle Free

$299.75

Single bottle of HoodiThin

  $59.95

Bonus Offer - Detoxify - 1 bottle
(when any other prouct is purchased)

$29.95
box

Bonus Offer - HoodiSpray - 1 bottle

$29.95
box

Prime Life HGH - 1 bottle

$39.95
box

Detoxify - 1 bottle

$34.95
box

Green Tea Extract - 1 bottle

$29.95
box

TheraStress - 1 bottle

$39.95
 

Subtotal:

$.

Shipping:
* we only accept US orders

$9.95

Grand Total:

$.

4.

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

Prime Life Nutriceuticals / HoodiThin
165 Castilian Dr
Goleta, CA  93117

or Fax This Form to:

805-681-8201

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