Cleansepatch™
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.
 
6 MONTH SUPPLY Cleansepatch x 6 boxes -$113 Savings $199.99
 
5 MONTH SUPPLY Cleansepatch x 5 boxes -$70 Savings $179.99
 
4 MONTH SUPPLY Cleansepatch x 4 boxes -$45 Savings $154.99
 
3 MONTH SUPPLY Cleansepatch x 3 boxes -$25 Savings $124.99
 
2 MONTH SUPPLY Cleansepatch x 2 boxes -$10 Savings $89.98
 
1 MONTH SUPPLY Cleansepatch x 1 box $49.99
Shipping Information:
Name:
  
Address:
  
City/State/Zip:
  
Telephone:
  
Email Address:
  
Amount Enclosed:
Write in the amount for the Cleansepatch supply you chose:
 $
Shipping and Handling:
 $
TOTAL ORDER IN US DOLLARS:
 $