Print this sheet for your order and mail. This is 1 page long.
If you want a 3 page long order form listing all products, click here.
NO PRINTER? If you do not have a printer, carefully write out your order with your name, mailing address and a contact phone number in case we are not certain what you are ordering.
Celeste's HCG Mail-In Order Sheet
    We will send your order by U.S. Post Office FAST PRIORITY MAIL for FREE and email you the tracking number.  Fill-in your order and mail our order. We will rush your order back to you.
Free USPS Priority Mail. HCG & B-12 Complex in Amber Glass Dropper Bottles
What you are ordering: ____________________________________________________________



 TOTAL: $________________ 
  Date: ________________________

  Name: ______________________________________________

  Address: ____________________________________________________________________

  Apt/Unit/Suite #__________________

  City: ___________________________________________ State ___________ Zip __________

  Contact Phone Number: _________________________________

   Email Address for your tracking number: _____________________________________

  Special Instructions if any: ________________________________________________
  (Use back of page if you need to provide more info)

   I verify that I am at least age 18: ________________________________
                                                           Signature or Initials
"Pure Health"

Mail To:
Pure Health
Attn: Celeste
P.O. Box 636
Crystal River, Florida 34429