Thank you for choosing Healthy Solutions Products.

Please print this form, fill it out, and mail it to:

Healthy Solutions
P.O. Box 276, Ashley, MI. 48806
Fax: (989) 862-5394
888-858-SLIM

Please make your check or money order payable to: "Healthy Solutions."
PRINT clearly, and be sure to fill in this form completely. Once we have received your order, it will be processed immediately.

To Print: Right Click your Mouse>Choose PRINT

Shipping Address:

First Name: _____________________________________________________________

Last Name:______________________________________________________________

Street, Apt.: _____________________________________________________________

City: ___________________________________________________________________

State/Province: ________ Zip/Postal Code: __________ Country: ___________________

Is the Billing Address the same as the Shipping Address? ____ Yes ____ No
If "NO", please enter Billing Address:

Street, Apt.: ____________________________________________________________

City: __________________________________________________________________

State/Province: ________ Zip/Postal Code: __________ Country: __________________

Contact Information:

Phone Number (include area code): __________________________________________

Fax Number (include area code): ____________________________________________

E-Mail Address:______________________@___________________________________

Payment Method: ____ Visa ____ MC ____ AMEX ____ Check ____ Money Order

Credit Card Information:

Card Number: _____________________________________ Expiry Date: ____________

Name On Card: __________________________________________________________

Authorized Signature:______________________________________________________

Please indicate an order option:

Dietary:
____ Honey Essentials $25.99
____ Supreme Grapefruit $25.99

Express Shipping:
____ Express Shipping $21.99

Gift Certificates:
____ Gift Certificates $49.99

Joint Relief:
____ Joint Relief™ 1 Month Supply $29.95

Menopause:
____ Supreme Relief Menopause Sample FREE 1 weeks supply $0.00
____ Supreme Relief Menopause™ $29.95

Smoking:
____ Smoke Break 1 Month Supply $29.95
____ Smoke Break 2 Month Supply $55.00
____ Smoke Break 3 Month Supply $85.99


Starter Gift Packs:
____ Starter Pack: Weightloss: Calogel, Citrisept and Omega $99.99
____ Starter Pack Deluxe:Calogel, Citrisept, Omega & Multi Vitamin $125.99
____ Starter Pack Ultra Deluxe Pack $326.70
____ Starter Pack: Lower Your Cholesterol™ $149.00

Vitamins:
____ Liquid Multi Vitamin $29.95
____ Omega Supreme 1 Month $29.95
____ Omega Supreme 2 Month $59.90
____ Omega Supreme 3 Month $89.95

Wrinkles:
____ Supreme Touch™ Collagen Serum $29.95
____ Supreme Touch™ Collagen Serum 2 Month Supply $49.00

Yeast:
____ Citri-Sept™ $29.95

Calogel:
____ Calogel™ 1 Month Supply $55.00
____ Calogel™ 2 Month Supply $110.00
____ Calogel™ 3 Month Supply Free Regular Shipping $49.00 per bottle $147.00
____ Calogel™ 4 Month Supply Free Regular Shipping $49.00 per bottle $196.00
____ Calogel™ 6 Month Buddy Pack: 5 bottles @ $49.00 6th bottle 1/2 OFF! $269.50
____ Calogel™ Office/Family Pk. 11 bottles @ $49.00 w/1 FREE 12 total $539.00

Please indicate Calogel AM or Calogel PM

Calogel™ PM/Calogel™ AM Combo Pk.:
____ Calogel™PM and Calogel™AM Combo Pack 2 Month Supply $196.00
____ Calogel™PM and Calogel™AM Combo Pack 3 Month Supply $269.50


Shipping:
  1 Month Supply - $4.96
  2 Month Supply - $9.92
  3 Month Supply - FREE SHIPPING
  Express Shipping - Additional $21.99

*please indicate quanitity if more than one bottle desired

*if you are ordering express shipping and paying by check by phone then it will take 3 business days to clear then your order is express shipped