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Dr. Laurence Galant
Health & Nutritional Guidance Center.
561-577-0548
12077 Colony Preserve Drive
Boynton Beach, FL 33436

drgalant@truthinhealth.com

RevitalizePlus Order

Please complete the following form and click Submit.

Your product order will be shipped within 24 hours. Thank You.

		First Name *		Last Name *

		Street Address *

		City *		State *		Zip Code *

		E-mail Address *

Promo Code ID# (if none use HNGC) in the box. *

		Contact Phone *		How do you wish to be contacted?

How did you hear about us?

Yellow Pages	Internet
Newspaper	Other
Post Card	Friend

If you have a Promo Code Placed here!

Select Your Qualifying Order Level:

CUSTOMERS ONLY

1 FREE Bottle monthly Autoship. New Customers only. $14.97 shipping and monthly autoship program. (Autoship Program See IMPORTANT NOTICE below).

1 bottle monthly Autoship. Includes: Any 1 bottle of RevitalizePlus, @ $49.97 each bottle, plus $14.97 shipping/handling. (Autoship Program See IMPORTANT NOTICE below).

IMPORTANT NOTICE: By your acceptance and participation in this Offer, you will automatically be entered into the Autoship Program for your second month and you will be charged at the level you choose for your second month Autoship order. (See below for level options)

FREE Marketing and training manual. Offer a FREE BOTTLE of product to your prospects. (Optional - check the box for a FREE training manual).

Option 1 -3 bottles Pack monthly Autoship. Includes: Any 3 bottles @ $100 each (3 bottle pack), plus FREE shipping/handling. You can save the $14.97 shipping charges if you choose this option. Use the first bottle and if you are not completely satisfied, Return the other two bottles for a complete refund. (Auto ship is optional).

Option 2 - 12 bottles Pack monthly Autoship. 4 three Paks 12 bottles @ $300, plus FREE shipping/handling. Save $180. from the single bottle purchase and $100 from the 3 bottle pack purchase. (Auto ship is optional).

Option 3 - One Bottle monthly Autoship. One bottle per month on autoship for $49.97 plus shpping. Month to month $59.97 plus shipping.

DISTRIBUTORS ONLY
Home Based Business Opportunity

By joining our Home-Based Business Opportunity today, this "Free Bottle First Month Offer" includes your first month order of one (1) BOTTLE absolutely FREE! You will pay ONLY $14.97(USD) for shipping/handling. And, by joining today, you will, also, receive your FREE Corporate Marketing and Promoting Manual. This special FREE BOTTLE OF PRODUCT FIRST MONTH OFFER, and your position is locked into our Nation Wide FORCED FILLED MATRIX, FREE One-On-One Coaching.

IMPORTANT NOTICE: By your acceptance and participation in this Offer, you will automatically be entered into the Autoship Program your second month and you will be charged at the level you choose for your second month Autoship order which will maintain your Independent Distributorship in this Program as "active." You will also qualify for commissions starting your second month in the Program since your FREE BOTTLE generates no commissionable volume in the first month. I fully understand and agree that I may Upgrade to Silver, Gold, or Platinum level status during my first month. YOU WILL qualify for commissions immediately upon Upgrading during YOUR first month.

IMPORTANT FURTHER NOTICE: I fully understand and agree that by acceptance of this Offer and receipt of my first month's bottle of product FREE, I will remain in the program for at least two (3) consecutive months (inclusive of the first "Free" month). I, also, fully understand and agree that I may cancel my participation in the Autoship Program at any time. Said cancellation must be in writing only as per the Cancellation Policy as referenced in the Terms and Conditions of my Distributorship Agreement. Should I cancel before the expiration of two (3) consecutive months, regardless of the reason, I will be charged and I agree to pay $59.97 to cover the cost of the first month's bottle of product. However, I further fully understand and agree that, should I cancel, in writing, before the expiration of two (3) consecutive months and return the Unopened and Unused BOTTLE, in resaleable condition as per the Product Return Policy referenced in the Terms and Conditions of my Distributorship Agreement, I will NOT be charged $59.97 for that first month's bottle of product.

SEE BELOW

FREE BOTTLE-Fist Month Offer.($14.97. Shipping.)NEW Customers autoship Only

RevitalizePlus 1 Bottles $49.97 (Plus Shipping)Autoship

RevitalizePlus 3 Bottles $100 (FREE Shipping) SAVE $20.

RevitalizePlus 12 Bottles $300 (FREE Shipping) SAVE $180.

Distributors/Existing Customers Only. Check this box, Select your choices below!

1 bottle $49.97 Plus shipping

3 bottles No Shipping. SAVE $20. FROM SINGLE BOTTLE PURCHASE

12 bottles No Shipping. SAVE $180. FROM SINGLE BOTTLE PURCHASE

AUTOSHIP

FREE training manual.

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Copyright all rights reserved 1997-2008. The Health and Nutritional Guidance Center Web Health Education Center, World rights reserved. Information on this web site may not be re-published or used partly or in total without written consent of the copyrighter. This information is presented solely for health education purposes and to educate you in helping yourself in removing causes of diseases. We are researchers and educators, we do not diagnose, treat any diseases or give medical advice. The publisher and contributors are not responsible for the actions of the readers. The readers are advised to educate themselves, take full responsibility for their actions and health, and when health guidance is needed, seek out the services of qualified health professionals. (See "Health Disclaimer") on this Web Site.