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ORDER FORM

Reale Natural Inc.

THIS IS A SECURED SERVER PAGE. YOUR DATA IS SAFELY ENCRYPTED AND IS SAFE FROM UNAUTHORIZED ACCESS.

Billing Information
*Full Name:
Company:
*Day Phone:
Home Phone:
Fax:
*Email:
*Retype Email
*Address1:
Address2:
*City:
*State/Province/County:
*Postal/Zip Code:
*Country:
Where did you hear about us?
*Indicates a REQUIRED FIELD
Please check this box if you wish the shopping cart to remember your personal information for future purchases.

Ship To Information
Please leave blank if same as billing address.
Ship To Name:
Ship To Address1:
Address2:
City:
State/Province/County:
Postal/Zip Code:
Country:

Credit Card Payment Information
Name on Card:
Card Type:
Card Number:
Expire Date:		Month: Year:

Product Order Information

Quantity	Description	Total
	(H053H) EverCLR (240mg, 90 caps) $49.95	$
	(H053H1} "Intro Offer" (2bottles + 1 FREE) $99.90/pkg.	$
	(H053HR) "Reorder Special" (3 bottles + 1 FREE) $149.85/pkg	$
	(H053H12) 20% Discount Special on 12 blts. $479.52 pkg.	$
	(H073)) NuIQ @ $19.95/bottle.	$
	( H060A) Cabernet Capsules™ @ $29.95/bottle.	$
	(H061) Brain Power™ @ $39.95/bottle.	$
	(H067) Joint Comfort @ $39.95/bottle.	$
Product Total		$
%		$
Shipping Method		$
Grand Total		$

Please note: SHIPPING & HANDLING - U.S.A.: Add $7.50 for Priority Shipping & Handling; ALL OTHER COUNTRIES: Add $15.00 for International Priority Shipping & Handling.

Comments/Special Delivery Information

I authorize Reale Natural Corporation to charge me for the above total.
I further affirm that the name and personal information provided on this form are true and correct.

I further declare that I have read, understand and accept Reale Naturall Corporation's business terms as published on the web site.

By pressing the ORDER button below, I agree to pay Reale Natural Corporation.

ORDER PROCESSING MAY TAKE UP TO 90 SECONDS.
TO PREVENT ERRORS, PLEASE CLICK THE ORDER BUTTON ONLY ONCE.

EverCLR Homepage

To place an order, simply fill out this form and click on the Submit Order button at the bottom of the page.

Type in quantity of bottles you wish to order below.

Please send me (H053H) bottles of EverCLR @ $49.95/bottle.

Please send me (H053H1} "Intro Offer" (2bottles + 1 FREE) $99.90/pkg

Please send me (H053HR) "Reorder Special" (3 bottles + 1 FREE) $149.85/pkg

Please send me (H073) bottles of NuIQ @ $19.95/bottle.
Please send me ( H060A) bottles of Cabernet Capsules™ @ $29.95/bottle.
Please send me (H061) bottles of Brain Power™ @ $39.95/bottle.
Please send me (H067) bottles of Joint Comfort @ $39.95/bottle.

Newsletter ...........................Free with order.

Include $7.50 Shipping & Handling charges per order.

Quantity Discount: Order 12 bottles and SAVE 20%.

Billing Information
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Address
Address
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Where did you hear about us?
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Or who referred you

Credit Card Information
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Credit Card #
Expiration Date

Shipping Information (if different than billing information)
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Address
Address
City
State
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COMMENTS:

EverCLR has effectively worked for 96% of the people who used EverCLR and stayed on the program for one year.

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