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>> PLEASE READ ALL INSTRUCTIONS CAREFULLY <<
* REQUIRED FIELDS

*First Name: *Last Name:Middle Initial:
*Address:*City:*State:*Zip:
*Country:*Area Code:*Phone Number:*E-Mail:

Select All Items Being Ordered From >>> Pull Down Menu's

Quantity	Description	@	Total

Merchandise Total	$
Shipping & Handling	$
Total Amount of Order	$

CREDIT CARD INFORMATION

*Credit Card Number *Expiration Date
*Which Credit Card Are You Using ? * Name on Card

Signature (Required for fax or mail order)________________________________HFM

Shipping & Handling;1-2 Bottles $6.95, 3-5 $7.95, 6-8 $8.95, 9-12 $10.95
All Items Shipped To The United States Are Shipped United Parcel Service
Delivery Time Is 3-7 Days - Canada Add $2.00 to Each Item
Orders To Foreign Countries: Shipping Charges Will Be Added To Your Credit Card
We Ship Air Parcel Post 7 - 14 Days Delivery Time. We Ship To More Than Countries

__________________________________________________________________________________________
NOTE: There is No Submit Button On This Form, It Is For Printing Out Faxing or Mailing Only!

All Checks Must Have Bank Clearance Before Order Is Processed
There Is A $35 Fee For All Returned Checks
All Money Orders And Credit Card Orders Are Shipped Quickly

MAIL ALL ORDERS TO
A Healthy Alternative, LLC
P.O. Box 6013
Long Island City, New York 11106
FAX ALL ORDERS TO: (718) 850-9682 or (718) 850-9685

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