Print this Fax Order Form 




√    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 (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_____________

Frequency Rising

45277 Aguila Ct. Temecula CA, 92592

ph (951)303-3471    
fax (603)-994-1746


Thank you for your order.  You will receive a "paid" invoice with your product order.