Fax Form Essiac

Alternative Health Products International

FAX Order Form: Print, fill this form and Fax it to: 250-339-0286

Quantity and Product name ordered
(Example: 8 Essiac, or 80 Rooibos) :...........................................................

Your Name:...................................................................................

Address:.......................................................................................

City:..............................................................................................

State& Country:.......................................................................

Post./Zip code:..........................

Phone:(........)....................................

Fax:(..........).................................

Email:..............................................

Discover, American Express,
MasterCard or VISA.# ................. ................. ............... ..............

Expiration Date:......../........

Signature:.......................................

We accept money orders and cheques.Orders Are Shipped The Same Day if we received it before 3 Pm Pacific standard time (6 Pm Eastern).