Fill out the information below and press the submit button.  You will receive a response with 24 hours.

Which product would you like to order?

Extreme Power Plus Herb Supplement............Quantity?  ..... $12.95 per bottle*
Extreme Colon Cleanser Supplement.............. Quantity? ..... $12.95 per bottle*
Fat-N-Emy Herb Supplement........................ Quantity?  ..... $12.95 per bottle*
Weight Loss Instant Coffee............................ Quantity?  ..... $10.00 per bottle*
                                                                                                                    *Prices do not include shipping & handling

Tell us how to get in touch with you:

Name:
Street Address:
City, State, Zip Code:
Work Phone:
E-mail:
Home Phone:
FAX:
Special Instructions or Comments:
Please contact me as soon as possible regarding this matter.


Created by Karen Yaughn
Copyright © 2000 [Ivey Designs & Services]. All rights reserved.
Revised: July 07, 2000 .