FAX - MAIL Order Form Page - AlgaeCalPlus.com

Fax/Mail Order Form
We accept Visa / Mastercard, Check or Money Order


Item		Price US$:	Qty:	Subtotal:
AlgaeCal Plus® - 90 Capsules
1 to 5 bottles		$29.95	X	= $
6 to 11 bottles		$24.95	X	= $
12 or more bottles		$21.95	X	= $
Strontium Boost™ - 90 Capsules
1 to 5 bottles		$21.95	X	= $
6 to 11 bottles		$17.95	X	= $
12 or more bottles		$16.95	X	= $
The Kitchen Sink™ - 180 Capsules
1 bottle		$44.95	X	= $
2 to 5 bottles		$39.95	X	= $
6 to 11 bottles		$32.95	X	= $
12 or more bottles		$29.95	X	= $
	1 Subtotal			$
	2 Shipping
	3 Total Payable		Add lines 1 & 2	$

Billing Address
Your Credit Card can only be processed if correct address and phone number that your credit card is registered to is supplied.

Name:

Address:

City:

State/Province:

Zip/Postal Code:

Country:

Phone #:

Email:
(for order confirmation)

Credit Card Information

Credit Card:

Visa MasterCard

Card #:

Card Expiry:

Month: Year: CVV2# :

Name:
(as shown on card)

Shipping Address (Only if different then your Billing Address)

Address:

City:

State/Province:

Zip/Postal Code:

Country:

Phone #:

Mail Order Form with payment to
HL Distribution Co. #2805 - 1323 Homer St., Vancouver, BC, Canada V6B 5T1
or by Fax to 604-602-9015