LIFEPLUS Products
SSL Secured Order Form

24 Hour Ordering -||- International Customers Are Welcome!


** If you are experiencing trouble using or loading this page, CLICK HERE to use our alternate secured order form **

SPECIAL ORDERING INFORMATION


PURCHASER INFORMATION

E-mail Address:
Important: the 'E-mail Address' field is a REQUIRED field.
Please enter your exact e-mail address, otherwise this form will not work properly.
(we will send a confirmation to you at this address after your order has been processed)
  
Lifeplus PIN:
 (leave blank for first time orders)
  
First Name:
Middle Initial:
Last Name:
  
Street Address:
Address Line 2:
City:
State / Province:
Country:
Zip / Postal Code:
  
Telephone Number:
Fax Number:

SHIPPING ADDRESS
(if different from above)

Ship To Full Name:
Street:
City:
State / Province:
Country:
Zip / Postal Code:


PRODUCT SELECTION

ITEMQTY PROD #   PRICE   DESCRIPTION  (size; weight)
1.
2.
3.
4.
5.
6.


Special: buy 6 of any one product and get 1 FREE!

ORDER TOTALS

   PRODUCT SUBTOTAL:  <-- Enter the total of the above selected items
           SHIPPING:  <-- Actual cost of shipping will be added to all orders
                                        CLICK HERE to view the Shipping Charges Chart
    LOCAL SALES TAX:  <-- Sales tax for your area
              TOTAL:  <-- TOTAL COST OF ORDER

Note: if desired, you do not have to complete the SHIPPING or LOCAL SALES TAX fields above. The
actual total cost of your order will be determined and an e-mail confirmation will be sent within 24 hours or
the next business day.


CREDIT CARD PAYMENT INFORMATION

Please select type of card: 

       Card Holder's Name*: 
                             * EXACTLY as it appears on the card.
                            
        Credit Card Number: 

   Expiration Date (mm/yy): 

  Card Security Code (CVN):  (what's this?)



Please enter any COMMENTS, special messages, or instructions:



(click button once and wait for the confirmation)


Your comments and suggestions are appreciated.
If you have any problems with this form please send an e-mail to: sandi-q@archangelhealth.com


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