Mail Order Page - Constant Focus
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Print & mail with payment to:
398 E. Dania Beach Blvd #400
Dania Beach, FL 33004
Dania Beach, FL 33004
  SHIPPING INFORMATION
First and Last Name:
Street Address 1:
Street Address 2:
City:   State/Province:
Zip Code:   Country:
Email Address:   Phone Number:
QUANTITIES - Enter quantities and the form will calculate your total
Qty SKU Item Name Price Subtotal
COF-1 Constant Focus: 1 Month Supply $49.95 $0.00
COF-3 Constant Focus: 3 Month Supply $124.95 $0.00
COF-6 Constant Focus: Buy 4 Get 2 Free $199.95 $0.00
SHIPPING - Order over $239.00 receive free ground shipping
UPS Ground Shipping - $7.95 UPS Next Day Air - $22.95
UPS to Canada (CANADA ONLY) - $14.95 UPS International - $19.95
UPS 2nd Day Air - $12.95 UPS 3-Day Select - $9.95
UPS Ground Shipping - $0.00 UPS Next Day Air - $22.95
UPS to Canada (CANADA ONLY) - $14.95 UPS International - $19.95
UPS 2nd Day Air - $12.95 UPS 3-Day Select - $9.95
Subtotal: $0.00
Shipping: $0.00
Total: 0.00
Mail in US Dollars, Cashier Checks or Money Orders payable to: "Health Formula". 
PAYMENT DETAILS
If you are paying by credit card, please fill in the required information below:
Card Number:
Card Expiration Date (MM/YY):
/ CVV2 Number: What is the CVV2 number?
Name as it appears on card:
Credit Card Street Address:
Credit Card City, State:
Credit Card Country:
Credit Card Zip Code:

Cardholder Signature:
Please select the credit card type used for this order:
MasterCard
Visa
American Express
Discover Card
 
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