Dr. Orman's Hgh Plus Order Form

For those who wish to pay via Check or Money Order, please print this page and mail with payment.

Name:__________________________________________________

Mailing Address:_________________________________________________

City:__________________     State:______   Postal Code:_________

Phone:________________

Number of Bottles:_________

• 1 bottle = $69

• 3 bottles = $189*

• 6 month Auto ship = $60/mo.*

• 12 month Auto ship = $53/mo*

• 24 month Auto ship = $45/mo*

* = Additional benefits included. The above costs include shipping and handling.

Special Instructions:___________________________________________

Please make checks payable to:

Dezine Management Inc.

Attn: Order Dept, Lisa

661 Huntington Pines Dr.

Ocoee, FL 34761 USA

Thank you for your order.