Natural Health Solutions
RETAIL ORDER FORM
Order Department * 9745 Kristen Drive * Sandy, UT 84070
Phone/Fax 888-232-6706

BILL TO:  SHIP TO: (If Different)
Name:  ___________________________  ___________________________
Address:  ___________________________   ___________________________
City, State, ZIP:  ___________________________     ___________________________
Telephone:  ___________________________     ___________________________

Qty

Product #

Description

Retail Price

Total
  CB Country Beans

$14.95

 
  NATM Natural Meals in Minutes *Out of Stock*

 
  123 1-2-3- Smoothies

$14.95

 
  PS Passport to Survival

$15.95

 
  FC Food Combining

$7.95

 
  NSHT Natural Sweets and Healthy Treats

$7.95

 
  QWF-V Quick Wholesome Foods Video

$29.95

 
  QWF-D Quick Wholesome Foods DVD

$29.95

 
  GSE2 GSE 2oz Liquid
$10.95
 
  GSE4 GSE 4oz Liquid
$18.95
 
  GSECAP GSE Capsules Plus
$15.95
 

USPS Parcel Post
Shipping Rates
0 - $15.95 $4.00
$15.96 - $31.99 $5.00 SubTotal  
$32.00 - $63.99 $8.00 Shipping*  
$64 AND UP Free Shipping Total  

*ALL ORDERS WILL BE SENT USPS PARCEL POST OR PRIORITY.
ADDITIONAL CHARGES WILL BE ADDED IF PRIORITY IS SELECTED.

___PARCEL POST ___PRIORITY

Payment Type:  __ Check  __ Money Order

__ Credit Card (MC, Visa, AMEX, Discover)

Card # ______________________________________________________ Exp. Date: _______

Name (as shown on card): _________________________________________

Signature: ___________________________________________________

Account Security # ___________ (Last 3 digits of the number located on the back of your card.)

Print and Mail or Fax this form.
Orders will be shipped within one week of receipt
(Orders paid by check may be shipped after check clears.)