Flavay® Order Form

Print this page and fax or mail to:

Healthy Source, LP
19141 Stone Oak Pkwy., Ste. 104
San Antonio, Texas 78258

Fax: 1-800-997-8987

or +210-481-5662

Tel: 1-800-200-1203

or ++210-481-0067

Billing Information:

  • Name:
  • Address:
  • City:
  • State, Zip:
  • Country:
  • Phone:
  • Email:

Shipping (if different):

  • Name:
  • Address:
  • City:
  • State, Zip:
  • Country:
  • Phone:
Qty Product Name Price Ea. When
You Buy 1-2 		Price Ea. When
You Buy 3+		 Total
 

Flavay®

$48.75 $44.50  
 

Flavay Plus®

$78.00 $69.50  
*Shipping Price Chart:
  • U.S. Orders of $100 or more . . . FREE
  • U.S. Priority Mail . . . $ 6.50
  • U.S. Express Mail . . . $ 23.50
  • CANADA Priority Mail . . . $ 17.50
  • CANADA Express Mail . . . $ 25.00
  • INTERNATIONAL Priority Mail . . . $ 25.00
  • INTERNATIONAL Express Mail . . . $ 33.00
 Subtotal  
Shipping: See Chart at Left*  
No Sales Tax
Outside U.S.: may be subject to taxes at delivery.		  
Grand Total  

Method of Payment:

  • Check*
  • Money Order
  • Visa
  • MasterCard
  • Discover
  • American Express

*Please make check or money order payable to: HEALTHY SOURCE, LP.

  • Credit Card Number:
  • Expiration Date:
  • Name on Card:
  • Cardholder's Signature:

AutoShip:

Check below to Join AutoShip and receive: (1) lower member pricing on your NEXT order and (2) convenient monthly or bi-monthly delivery:

  • Monthly
  • Bi-Monthly1 (Jan-Mar-May-Jul-Sep-Nov)
  • Bi-Monthly2 (Feb-Apr-Jun-Aug-Oct-Dec)

© Healthy Source LP.

[ 0000 ] Effective date: May 12, 2007