|
|
|
|
|
|
|
|
|
|
| Healthy 'n Fit
Weight Management Program Order Form |
|
| Shipping
Information |
|
| Company Name |
|
|
|
|
|
| Name |
|
|
|
|
|
| Address |
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| Phone Number |
|
|
|
|
|
| Email |
|
|
|
|
|
|
| Product List |
Cost |
Quantity |
|
| Healthy 'n Fit Weight Management Individual
Program (CD-ROM) -
Original Cost $795 - Order
Before December 31st 2008 and save 30%!!!- Subtract $280 |
$515 |
|
|
| Healthy 'n Fit Weight Management Individual
Program CD-ROM with Print Version |
Add $50 |
|
|
| Healthy 'n Fit Weight Management Program - Group
Program (CD-ROM) - Order Before December 31st 2008 and
save 30%!!!- Subtract $280 |
$515 |
|
|
| Healthy
'n Fit Weight Management Group Program CD-ROM with Print
Version |
Add $50 |
|
|
| BOTH Programs with CD-ROM (save 30% off the first
program and 60% off the 2nd!!! - Discount until December 31st 2008- Original
Price $1192) |
$834 |
|
|
| |
Both programs with CD-ROM
with Print Version |
|
Add $100 |
|
|
| 1
Month Email Counseling for Program Set-Up (retail value $150) |
|
FREE! |
|
|
|
|
|
|
|
|
Total Cost: |
|
|
| Payment Method (Please Check One) |
|
| Visa |
|
|
|
| MasterCard |
|
|
|
| American
Express |
|
|
|
| Check |
|
|
|
| Money
Order |
|
|
|
| PayPal
|
|
|
|
|
|
|
| Credit
Card Number:
____________________________________________ |
|
|
| Expiration
Date : _________________ |
|
|
|
| Card
Security Code: ______________ |
|
|
|
| |
|
|
|
|
|
| Cardholder
Name: ____________________________________________ |
|
|
| |
|
|
|
|
|
| Cardholder
Signature: ____________________________________________ |
|
|
| |
|
|
|
|
|
|
|
|
|
| Checks can be made out to Erin Palinski, RD. Please sent payment
via PayPal to the email address orders@dietitianresource.com. PLEASE DO NOT
SEND CASH IN THE MAIL. Items will be mailed out upon check clearance. FAX CREDIT CARD ORDERS TO (973) 858-0417. |
|
|
|
| Mail
Order to: |
|
| Healthy 'n
Fit Weight Management Program |
|
| Attn: Erin
Palinski, RD, LDN |
|
| PO Box 122 |
|
| Hamburg, NJ
07419 |
|
|
|
|
|
|
|
|
|
|
|