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Shipping Information:

Name:
________________________________________________________
Address:
________________________________________________________
City, Province/State,
Postal Code & Zip:
________________________________________________________
Phone:
________________________________________________________
In what magazine did you see our advertising? :
________________________________________________________
* (International Orders Only)
Email for Tracking:
________________________________________________________

Order Information:

Order Type
Quantity
Price
Shipping
Total
GST
Total
12 Month Supply
12
$650.00 CAD
included
$650.00 CAD
$32.50 CAD
$682.50 CAD
 
HST. ONT
$84.50
$734.50 CAD

   12 Month supply - $650.00 CAD.
   For larger order discounts, call operator.
   For orders outside of North America, add $40 shipping.
* For orders outside of North America, we will email tracking number.

Payment Information:

OPTION 1 >> Paid in full ( 1-time payment )

      [   ] Visa [   ] Mastercard [   ] Discover

      Card Number _______________________________________________ Expiration Date _______
 
      Signature __________________________________________________

OPTION 2 >> Payment Plan ( 3 equal monthly payments *NO INTEREST* )

      [   ] Visa [   ] Mastercard [   ] Discover

      Card Number _______________________________________________ Expiration Date _______
 
      Signature __________________________________________________

Mail or Fax to:

Canada
BIE Health Products
5468 Schueller Cresent
Burlington, ON L7L 3T2
 Fax: (905) 639-0957  		 USA
BIE Health Products
808 Proctor Avenue,
Ogdensburg, NY, 13669-2205
 Fax: (905) 639-0957 

Orders are shipped the day after they are placed, via Postal Mail. Please allow at least 10 days for delivery.



Copyright © 2000 BIE Health.