CleanseRX™
Mail Order Form
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Please print and fill out this form completely and mail it with your money order or bank draft in US dollars to:

Good Health Inc.
P.O. Box 1800
Canutillo, TX 79821
USA		 Please note: We accept money orders (US dollars) only. Sorry, we do not accept cash, personal checks, electronic checks, PayPal or COD orders.
 
4 MONTH SUPPLY CleanseRX System x 4 -$70 Savings $249.99
 
3 MONTH SUPPLY CleanseRX System x 3 -$40 Savings $199.99
 
2 MONTH SUPPLY CleanseRX System x 2 -$15 Savings $144.98
 
1 MONTH SUPPLY CleanseRX System x 1 $79.99

 

 
4 MONTH SUPPLY CleanseRX Phase2 x 4 -$30 Savings $169.99
 
3 MONTH SUPPLY CleanseRX Phase2 x 3 -$15 Savings $134.99
 
2 MONTH SUPPLY CleanseRX Phase2 x 2 -$5 Savings $94.99
 
1 MONTH SUPPLY CleanseRX Phase2 x 1 $49.99

Shipping Information:
Name:
  
Address:
  
City/State/Zip:
  
Telephone:
  
Email Address:
  
Amount Enclosed:
Write in the amount for the CleanseRX supply you chose:
 $
Shipping and Handling:
 $
TOTAL ORDER IN US DOLLARS:
 $