HGH 1000 PLUS - FAX In Order Form


Please click on the print icon above to print this form,
then enter the required information and fax to:

GHR Products

(877) 400-1110


SELECT QUANTITY BELOW:

Supply INITIAL PRICE AUTO REFILL PRICE
1 Month Supply - Autoship Program
 $64.50 $49.95
3 Month Supply - Autoship Program
 $129.00 $99.90
6 Month Supply - Autoship Program
 $204.00 $174.90
12 Month Supply - Autoship Program
 $351.00 $324.90

 

Supply

 

STANDARD PRICE.
(No Refills)

 
1 Month Supply - Ships Once
 $64.50 N/A
3 Month Supply - Ships Once
 $129.00 N/A
6 Month Supply - Ships Once
 $204.00 N/A
12 Month Supply - Ships Once
$354.00 N/A


California residents please add 8.25% sales tax.  All prices are in U.S. Dollars.

 

CUSTOMER BILLING INFORMATION

  FULL NAME:		 ____________________________________________________________
STREET ADDRESS: ____________________________________________________________
CITY, STATE, ZIP: ____________________________________________________________
COUNTRY/PROVINCE: ____________________________________________________________
TELEPHONE NUMBER: ____________________________________________________________
   
CUSTOMER SHIPPING INFORMATION (If different from billing)

  FULL NAME:		 ____________________________________________________________
STREET ADDRESS: ____________________________________________________________
CITY, STATE, ZIP: ____________________________________________________________
COUNTRY/PROVINCE: ____________________________________________________________
TELEPHONE NUMBER: ____________________________________________________________
   
PAYMENT INFORMATION
VISA MASTERCARD AMERICAN EXPRESS DISCOVER
NAME ON CARD: ____________________________________________________________
CARD NUMBER: ____________________________________________________________
EXPIRATION DATE: ____________________________________________________________

Your order will be shipped via USPS. If you wish to receive tracking information please be sure to include your email address.

AGE VERIFICATION

  I hereby certify that I am at least 18 years of age.

AUTHORIZATION

I authorize GHR Products to charge me for the above total. I further affirm that the name and personal information provided on this form are true and correct. I further declare that I have read, understand and accept GHR Products's business terms as published http://www.ghrproducts.com. By signing I agree to pay GHR Products.



  CUSTOMER SIGNATURE: ____________________________________________