CELLECT

Order Form

Contact Information

*First Time Ordering:

Information of Person Ordering

*First Name:

*Last Name:

*Billing Address:

Billing Address:

*City: *State/Province: *Zip or Postal Code:

Country:

*Phone Number: Mobile/Cell Number: *E-mail Address:

Referred By:

*Payment Method:

(Online Check and Credit Card Payment Orders are shipped after payment clears - in approximately 3-4 business days)

If using a card on file please enter the information below

Card Type: Last 4 digits: Expiration: CSC/CID:

Shipping Information

Shipping Address same as Billing Address:

Ship to First Name: Ship to Last Name: Phone Number:

Shipping Address:

City: State/Province: Zip or Postal Code:

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E-mail for Tracking: Same as Above or enter different Email:

CELLECT™ Complete Kit

SKU	Item	Servings	QTY	Price	Description
C-UNF30K	Complete Unflavored Powder Kit	30 servings		$110 per kit	Unflavored Powder and Cod Liver Oil Softgels Includes FREE shipping on orders of 2 or more within the USA

Additional CELLECT™ Options

SKU	Item	Servings	QTY	Price	Description
C-UNF30	Unflavored Powder Only	30 servings		$100 each	Unflavored Powder ONLY Includes FREE shipping on orders of 2 or more within the USA
C-CLO30	Cod Liver Oil Softgels Only	30 servings		$10 each	Cod Liver Oil Softgels ONLY

Domestic shipping within the USA:

Orders of CELLECT™ Dietary Supplement powder: FREE SHIPPING on orders of 2 or more

International shipping (outside of the USA):

Rate will be calculated and emailed when order is received.
Shipped via USPS International (3-9 Business days to arrive at foreign customs office)

Special Instructions or Questions: