Elixir Industry Fax/Mail Order Form - Easy Form

For U.S. Only. All Funds Are in US Dollars

Print And Mail Or Fax, Or Simply Write Down On Paper

All Orders Are Processed Within 24hours Upon Receipt.

We Are Open 24hours a Day, 7days a Week.

Fax: 1-714-908-7264

Make Money Order/Bank Draft/check payable to Elixir Industry

EZorb Powder

EZorb Capsules

Marvlix

Total Incl. Shipping

Check One

1

 

 

$43.90

 

 

1

  

$46.90

 

 

 

1

$44.90

 

3

 

 

$110.04

 

 

3

 

$118.41

 

 

 

3

$112.83

 

6

 

 

$202.05

 

 

6

 

$217.89

 

 

 

6

$207.33

 

2

1

 

$112.83

 

1

2

 

$115.62

 

2

 

1

$110.97

 

 

2

1

$116.55

 

1

 

2

$111.90

 

 

1

2

$114.69

 

 1

1

1

$113.76

 

 3

3

 

$209.97

 

 

3

3

$212.61

 

 3

 

3

$204.69

 

4

2

 

$207.33

 

2

4

 

$205.57

 

 

4

2

$214.37

 

 

2

4

$210.85

 

12

 

 

$370.54

 

 

12

 

$400.06

 

 

 

12

$380.38

 

6

6

 

$385.30

 

 

6

6

$390.22

 

6

 

6

$375.46

 

For more selections use the regular fax/mail order form

Name:

Phone:
CC#: 

CC Exp. Date:

CC 3-4 Digit Code:

Billing Address

Street:

City:

State:

Zipcode:

Mailing Address (if different)

Street:

City:

State:

Zipcode:

Fax completed form to 1-714-908-7264, or, mail completed form with money order or check to:

Elixir Industry, PO Box 8819, Brea, CA 92822-5819, USA