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BBS Order Form |
Print page & mail or fax order |
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Fax order to: |
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509-752-9572 |
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Mail order to: |
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Benevive LLC |
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1497 Main St.#223, Dunedin, FL 34698 |
Date: |
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Name: |
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Ship to Address: |
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City: |
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State: |
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Zip: |
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Phone#: |
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Email: |
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Card Type |
Visa / MC / Amex/Discover ( Make Money Orders & Checks to
Benevive LLC ) |
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Card Number: |
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3 digit code |
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Expiration Date: |
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Name on Card: |
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Billing Address: |
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Signature: |
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Quantity |
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Amount |
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BBS Renovati Cleanse IV-P |
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$1,169.00 |
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BBS Renovati Cleanse II |
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$799.00 |
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BBS Renovati Cleanse I |
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$531.00 |
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Module(Array) |
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$115.00 |
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Foot Tub with 20 liners |
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$34.95 |
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Other Items |
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USA & CDA Shipping |
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Intl Shipping |
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$185.00 |
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Tax 7% Florida |
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www.detox4vitality.com |
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Total: |
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