Form Options:
1) Fill in the form & click on the "Print" button below.
2) Or print first, fill in by hand & fax or mail in.

Print it out, mail it in!
or Fax to:
1-941-485-3145

 SHC, c/o Potent Hoodia
8437 Tuttle Ave. #403
Sarasota, FL 34243-2868
1-800-701-4556
Name: Phone:
Address: City:
State: Zip:
Potent Hoodia Elixir Purchase Options:  
Buy 2 Bottles Get 1 FREE (Total 3 bottles) > Price $107.92
1 Bottle (20-30 Day Supply) > Intro Price $53.96

 

Credit Card:
 
VISA
MasterCard
Discover Card
American Express
Subtotal:
Shipping & Handling - US only. (UPS Ground Delivery - $9.95)
(US 2 Day Rush Delivery - $19.95)
(US Next Day Rush Delivery - $39.95)
(Alaska, Hawaii, Puerto Rico US Virgin Islands - $12.95)
(All International Orders - $19.95)
Total:
Card#:   Exp. Date:

Signature (Please sign after printing out form if using browser): _____________________________


I authorize SHC to charge US$____________ to my credit card for purchase of the above.

Note: All orders will be shipped within 48 hours (those with checks will be held until cleared). Credit card charges will appear as SHC.

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