EnhanceRx™ Mail Order Form
Simply Print and Mail OR Fax
Toll Free Fax: 1-250-658-6722
Must be 18 years or older to purchase
Make Checks Payable to: Elite-Fulfillment.
Please fill out the following form. Check the box next to the product
you wish to order, and then mark the quantity you wish to order.
|
Product |
Quantity |
Price |
Amount |
||
| EnhanceRx Ultimate Package - 1 Year Supply | $389.99 | $ | |||
| EnhanceRx Supreme Package - 6 Month Supply | $ 234.99 | $ | |||
| EnhanceRx Platinum Package - 5 Month Supply | $ 214.99 | $ | |||
| EnhanceRxGold Package - 4 Month Supply | $ 169.99 | $ | |||
| EnhanceRx Silver Package - 3 Month Supply | $ 139.99 | $ | |||
| EnhanceRx Test Package - 2 Month Supply | $ 94.99 | $ | |||
| Enhance-Rx Single Bottle - 1 Month Supply | $ 49.99 | $ | |||
|
All prices are in US Funds.
|
Sub-Total | $ | |||
| + Shipping | $ | ||||
| Tax Included | $ 0.00 | ||||
| Total Order | $ | ||||
|
Thank
you for your Order. Additional
Information and/or |
Credit Card Number
(no spaces) Expiry Date_________________________________ CVV2#_____________________________________ Card Type__________________________________
Make checks payable to:
Name:_____________________________________ Address:___________________________________ __________________________________________ __________________________________________ Phone:____________________________________ E-Mail:____________________________________
Ref. # |