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Billing Address Name: ________________________________ Address: _______________________________ City, State, Zip: __________________________ Telephone: _____________________________ Email: _________________________________


Quantity Product Title


Hope For Health Product Order Form Shipping Address


Name:________________________________ Address:_______________________________ City, State, Zip:__________________________ Telephone:_____________________________ Email:________________________________


Price Each Total


This order is prepaid by: o Check/Money Order o MasterCard o Visa o Discover Card Number: ___________-___________-___________-__________ Expires: ____/____ Signature: _______________________________


To Order: Call: 1-800-468-7884 Email: shipping@hopeint.org


Mail: 151 Ascension Lane Marshall, N.C. 28753


Online: www.hopeforhealthusa.com


Please make checks and money orders payable to Hope For Health


USA Shipping


$0.01 - $25.00 ............. $6.25 $25.01 - $50.00 ........... $9.25 $50.01 - $100.00 ........ $13.50 $100.01 - $200.00 ...... $16.75


$200.01 or more! ........ $FREE


Subtotal Shipping Order Total


Canada Shipping


$0.01 - $25.00 ............ $12.00 $25.01 - $50.00 .......... $26.00 $50.01 - $100.00 ........ $36.00 $100.01 - $200.00 ...... $39.00


$200.01 or more! ........ $25.00 International Orders (Outside the US and Canada) & Bulk Discount Orders


All other foreign orders and bulk discount orders must be made by phone or email. Due to postal rate increases, we charge the actual shipping cost on these orders. Please call us at: 1-800-468- 7884 or 1-828-649-0278, or email us at shipping@hopeint.org for more information.


Order Form/Return Exchange 10/15/2012.indd 1


10/15/12 11:45 AM


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