√ Please send me the following product order: Product Name / Description # Units Price Each Total Price .1._________________________________________ _______ ________ __________ .2._________________________________________ _______ ________ ___________ .3._________________________________________ _______ ________ ___________ 4._________________________________________ _______ ________ ___________ .5._________________________________________ _______ ________ ___________ 6._________________________________________ _______ ________ ___________ 7._________________________________________ _______ ________ ___________ .8._________________________________________ _______ ________ ___________ .9._________________________________________ _______ ________ ___________ 10.________________________________________ _______ ________ ___________ Sub Total $______________ (CA Only: Sub Total x .0775) Sales Tax $______________ ** Shipping $______________ TOTAL PURCHASE PRICE $_______________ ** Please CALL FOR SHIPPING quote. Some products include shipping in the price, while some do not. We ship Priority Mail or FedEx Ground, unless otherwise specified. We are not responsible for the courier delivery to be on time. Every courier we've tried has been late on rare occasion. If a shipment is late arriving to you, let us know asap. We will retrieve any available credit from that courier. Products Disclaimer: The statements contained on these pages have not been evaluated by the Food and Drug Administration. Many of these products are NOT considered scientific by the FDA, nor are they even recognized. The products contained here are not intended to diagnose, treat, cure, or prevent any disease. Ideas presented in this document are for information only and should not be interpreted as medical advice, meant for diagnosing illness, or for prescriptive purposes. Readers are encouraged to consult their health care provider before beginning any cleanse, diet, detox program, or supplement regimen. The information in this document is not to be used to replace the services or instructions of a physician or qualified health care practitioner. RETURN POLICY: We will refund the full purchase price (minus shipping charges and a 10% restocking fee) within 30 days of purchase for any unused products that are returned to us in new and sellable condition, except where noted otherwise. Opened bottles of herbal products cannot be returned for a refund.
PAYMENT INSTRUCTIONS: Fill out this form completely. Fax this sheet to: 1-603-994-1746 Please make all checks and money orders PAYABLE TO: “Kangen Wellness" NOTE: Allow 4-5 business days for checks to clear prior to sending order. Credit Card Orders, please complete the following information. VISA_____ MC_____ Discover_____ AMEX_____ Card Number_______________________________________________________ Ex Date: _____/______ Name on Card (PRINT) ____________________________________________________________________ Billing Address____________________________________________ City___________________________ ST______ Zip__________ Phone # ______________________ Fax # __________________ C.V.V. # (required) _________________ ( 3-digit verification number in reverse italics on the back of your card) Email address:___________________________________________ (To receive delivery notification.) I agree here to waive the requirement for a physical imprint of my credit credit, as I'm making this purchase from my home or office, via facsimile machine, and authorize FrequncyRising.com (dba Kangen Wellness) to debit my credit card account. I have also read and understand the disclaimer and policies above.
Signed: X____________________________________________________ Date:_____/_____/_____
SHIP TO ADDRESS: (If different than address above) Name_____________________________________________________ Phone:__________________ City:________________________________________________________ ST______ Zip_____________
Thank you for your order. You will receive a "paid" invoice with your product order. |