Order Form

Fax to: 1-800-777-7914 Or, Mail it to:

Name:	_________________________	City:	_________________________
Email:	_________________________	State:	_________________________
Address:	_________________________	Country:	_________________________
Phone:	(____) ______ - ____________	Zip:	_________________________

1 Bottle BioMazing HCG Diet Drops + 1 Bottle Skinny Gazelle	_____ @ $99.95	= $ __________
2 Bottles BioMazing HCG Diet Drops + 2 Bottles Skinny Gazelle	_____ @ $150.00	= $ __________
3 Bottles BioMazing HCG Diet Drops + 3 Bottles Skinny Gazelle	_____ @ $299.85	= $ __________
4 Bottles BioMazing HCG Diet Drops + 4 Bottles Skinny Gazelle	_____ @ $240.00	= $ __________
5 Bottles BioMazing HCG Diet Drops + 5 Bottles Skinny Gazelle	_____ @ $499.75	= $ __________
1 Bottle hCG1234	_____ @ $59.95	= $ __________
2 Bottles hCG1234	_____ @ $89.00	= $ __________
3 Bottles hCG1234	_____ @ $179.85	= $ __________
4 Bottles hCG1234	_____ @ $129.00	= $ __________
5 Bottles hCG1234	_____ @ $299.75	= $ __________
1 Bottle HCG Diet Direct	_____ @ $139.99	= $ __________
2 Bottles HCG Diet Direct	_____ @ $279.98	= $ __________
3 Bottles HCG Diet Direct	_____ @ $419.97	= $ __________
4 Bottles HCG Diet Direct	_____ @ $559.96	= $ __________
5 Bottles HCG Diet Direct	_____ @ $699.95	= $ __________

SUB TOTAL		= $ __________
Shipping & Handling		= $ __________
TOTAL		= $ __________

Shipping Options:

Standard First-Class Mail via US Postal Service is FREE on orders over $69.95 (Domestic Only)
Standard First-Class Mail via US Postal Service just $9.95
Upgrade to USPS Priority Mail Delivery for $9.95 (Average 1-3 business days — US ONLY)
Upgrade to USPS Express Mail Delivery for only $39.95 (Overnight, most locations, (not available to APO, FPO) US ONLY)
USPS Priority Mail International Delivery for $29.95 (Average 6-10 business days — INTERNATIONAL)
Upgrade to USPS Global Air Mail Delivery for $99.95 (Average 3-5 business days — INTERNATIONAL)
Hawaii, Alaska, Puerto Rico, US Virgin Islands, Guam: $12.95

( ) I am enclosing a check or money order for $____________
Please note: If you are paying by check you must make it payable to SHC, LLC and mail it in. We do not accept checks by fax.

( ) I want to charge this purchase to my Credit Card

Credit Card (check one):

VISA MasterCard American Express Discover

Card Number: _________________________

Expiry Date: _________ Signature: _________________________

I authorize SHC, LLC to charge $____________ to my credit card for the purchase (and shipment) of the above products.

Note: If you are using a credit card charges will show up on your statement under SHC, LLC which is our parent company. All orders will be shipped within 48 hours of receipt. Orders accompanied by checks will be held until cleared.