ORDER FORM

(PLEASE PRINT)

Page 1

NAME: ______________________ PHONE:  (___) _____________
ADDRESS:  ____________________________________________
CITY: ____________________ STATE:_______ ZIP: ___________

PRODUCT

QUANTITY

TOTAL

CELLULAR NUTRITION
Shake Formula
  French Vanilla ..........................
  Dutch Chocolate .....................
  Wild Berry ...............................
  Tropical Fruit ...........................
Multivitamin ...............................
Cell Booster ..............................
WEIGHT LOSS PROGRAMS
Program A
  French Vanilla ..........................
  Dutch Chocolate ......................
  Wild Berry ...............................
  Tropical Fruit ...........................
Program B
  French Vanilla ........................
  Dutch Chocolate .....................
  Wild Berry ...............................
  Tropical Fruit ..........................
Program C
  French Vanilla ..........................
  Dutch Chocolate .....................
  Wild Berry ...............................
  Tropical Fruit ..........................
WEIGHT LOSS PRODUCTS
Green & Beige Herbal Tablets ..
Yellow Herbal Tablets ................
Herbal Energy Tea
  Lemon ......................................
  Raspberry ................................
  Peach .......................................
Fluid Loss ..................................
Fat Absorber ..............................
Protein Enhancer ......................
WEIGHT LOSS ACCELERATORS
Mental-Satisfaction ....................
Carbohydrate Protection ..........
Chewable Wafers
  French Vanilla .........................
  Chocolate Fudge .....................
  Strawberries & Cream .............
Herbal Chewing Gum ................
Energy Tablets .......................... Energy Protein Bars
  Chocolate Fudge ......................
  Peanut Butter ..........................
  Very Berry ...............................

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X $ 26.25 = ________
X $ 26.25 = ________
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X $ 21.75 = ________
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X $103.25 = ________
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X $164.00 = ________
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X $164.00 = ________

X $214.50 = ________
X $214.50 = ________
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X $ 14.50 = _________
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