Secure Online Order Form
bulletPlease fill out this form as completely as possible.
bulletMake sure you add the shipping and handling to your final total.
bulletIf you are a new member, make sure you pay the $6 sign-up fee
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Product

Price

Qty

      Total

 X

 

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 X

 

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 X

 

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 X

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 X

 

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 X

 

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GST/HST (for your area)

PST/OST (for your area)

Shipping & Handling (7% of Sub Total or $4.50 

or whichever is greater

 

 Sub Total

 

If new customer, add $6.00 to receive wholesale price listed in Product Pulldown List

Total

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You may use the space below for any questions or comments you may have concerning your order or American Longevity products.