Mail / Fax Order Form
*Print this page, fill out legibly, and send via mail or fax to:
HoodiaXR.com
Attn: Orders
3018 White St.
Metairie, LA. 70001

Website id #

FAX: Coming soon (Updated 11/22/11) 

USE BLACK INK!

1.

Customer Information (we can only ship to the U.S.)

Name:

Address:

(No P.O. Boxes)

City:

State:

 Zip: Phone:

Email:

________________________________________________________________*
* Be sure to include an email address you check regularly! (free email accounts)

2.

Payment Method (No Personal Checks) Date:_______________

Money Order / Cashiers Check (Payable to 'Great Herbal' in US$ only)

Visa / Master Card / American Express / Discover (circle one)

Credit Card Number:

Expiration Date:

/

CVV: *

 Signature: ________________________________

Money Order / Cashier's Check # ________________________________________________

3.

Select Products

Buy 1 bottle of HoodiaXR
(One Month Supply / 90 Pills)

$49.95

Buy 2 bottles of HoodiaXR
(Two Month Supply / 180 Pills)

$99.90 $84.95

Buy 3 bottles of HoodiaXR
(Three Month Supply / 270 Pills) Free Shipping

$149.85 $109.95

Subtotal:

$.

Shipping* (1 bottle order add $8.95)

$.

Grand Total:

$.


Website id #

 

 

DOUBLE CHECK ALL INFO FOR ACCURACY AND BE SURE TO INCLUDE AN EMAIL ADDRESS!
By Sending in your order request you are stating that you have read and agree to all the terms and conditions of this site.

Hawaii & Alaska orders add $10 to total for shipping. | No Personal Checks Accepted.

 

4.

Mail Form:

HoodiaXR.com
Attn: Orders
3018 White St.
Metairie, LA. 70001

or Fax Form to:

Coming Soon (Updated 11/22/11)

Allow 2-3 weeks (10-15 working days) for delivery. Orders that do not include shipping will be returned. Be sure to have correctly entered all information legibly. If faxing, please remember to keep all writing on the inside of the boxes and USE BLACK INK. Mail / Fax orders will not receive tracking information unless email information is entered correctly. Please double check all information prior to sending in.

Non-deliverable and/or returned packages will be billed the full amount of all shipping and handling charges (both directions).

Direct all inquiries to the Customer Service Ticket Center HoodiaXR.com/Contact and submit a trouble ticket. Trouble tickets are handled daily. Faxed inquires should allow 3-4 business days for reply.

We cannot deliver to Boxes.

*CVV Code on Visa/MC is the last three digits on the back of your card (not the card number). For Amex, the CVV is four digits on the front of the card (not the card number).

A signature must be included as well as the CVV code on all credit card orders.

By sending in your order request you are agreeing to all the terms and conditions of HoodiaXR.com.

Terms and conditions subject to change without notice. www.hoodiaxr.com/mailfax.htm for up to date information.

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