SECURE SERVER
To order by phone call:   800-378-1578  |  E-mail us for prices outside USA and Canada

Order Form USA and Canada All prices are US currency.
For each product, choose either Auto-Ship (Recurring) or Regular Purchase (Single).
PRODUCTS BELOW ARE MANUFACTURED BY HEALTHWAVE, INC:
	Auto-Ship (every month)		Regular Purchase
Product Name	Unit Price	Quantity Per Month	Unit Price	Quantity
Aroma Diet Patch®	$12.95 /mo	CHECK OUT	$14.95	CHECK OUT
Aroma Energy Patch®	$10.95 /mo	CHECK OUT	$12.95	CHECK OUT
PRODUCTS BELOW ARE MANUFACTURED BY ESSENTIALLY YOURS, INC:
Calorad® 2000 (Beef)	$40.00 /mo.	CHECK OUT	$42.00	CHECK OUT
Calorad® 2000 (Fish)	$40.00 /mo.	CHECK OUT	$42.00	CHECK OUT
Calorad® AM	$45.00 /mo.	CHECK OUT	$47.95	CHECK OUT
Definition® Drops	$40.00 /mo.	CHECK OUT	$42.00	CHECK OUT
Definition® Cream	$22.00 /mo.	CHECK OUT	$24.00	CHECK OUT
Essential Omega™	$27.00 /mo	CHECK OUT	$29.95	CHECK OUT
Ordering Information--Secure Server NOTE: *Indicates Required Information. All information is confidential...we do NOT sell addresses.
* Your Name: (First, Middle Initial, Last) * E-Mail: (For order confirmation purpose) * Credit Card Type: MasterCard    Visa    * Card Holder Name: (First, Middle Initial, Last) * Card Number: (xxxx-xxxx-xxxx-xxxx) * Expiration Date: (mm/yy) * Ship to Name: (First, Middle Initial, Last) * Address Line 1: (P.O. Boxes NOT acceptable)     Address Line 2: (Apartment or suite number, etc) * City:   * State or Province:   * Zip Code:   * Country: ----Please Select one---- United States Canada Other: E-mail us for prices. * Home Phone: (For shipment confirmation purpose)     Work Phone:     Have you ordered before? Have you ordered previously? We can expedite your order! I have NOT ordered these products previously I have ordered these products previously     Select Shipping method: Ground 7-10 days, (add 6%). Minumum charge is $4 2-Day (add 8%) Minumum charge is $7 Overnight (add 21%) and minimum charge is $18 Free Shipping on 5 or more boxes of Aroma Patch!     How did you hear about us? Please Select One Internet search, search engine Radio Advertisement TV Advertisement Newspaper or magazine advertisement Friend or Word of Mouth Aroma Patch distributor (please specify in comments section below) Physician or health care professional recommendation Other (you may specify in comments section below)
COMMENTS:
If you are interested in Aroma Patch® business opportunities, Please contact us. Send me free weight loss tips by e-mail    Do not send me the weight loss tips This order will be sent over Secure Encrypted Server.
State tax: Currently, we are not assessing tax on internet orders, but if required by your State on purchases made in the future, we will apply tax to products you purchase based on the retail total if you normally pay tax on these types of purchases in your state. Only Alaska, Delaware, Montana, New Hampshire, Oregon, and Washington DC residents are always exempt from state tax on internet purchases. Alaska, Connecticut, Delaware, Florida, Maryland, Michigan, Montana, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Texas, Vermont, and Washington DC residents pay no tax on Aroma Patch®. Shipping & handling: 6% shipping (unless you specified otherwise above) will be added to your order. Minimum shipping charge is $4.00. March and April Special: On orders of 5 or more boxes of the Aroma Patch®, we will ship them to you for FREE! You max mix your order (i.e. 3 weightloss + 2 energy, etc.) Credit card billing is by New Millenium, Inc. or by Nutrition Advisor Enterprises. Product satisfaction is guaranteed by manufacturer. Please allow 5-8 business days for standard delivery.
This order will be sent over Secure Encrypted Server.
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