Print this page and either mail to: SSLI Health Group
702 park Avenue  #302
South Pasadena, CA, 91030		 or call to 626-799-1302 first to Fax.
Fax to: 626-799-6702
 
Yes, Rush me Ultimate Gum Solution™ for my immediate usage. If I am not satisfied with your product within 90 days of purchase I can return it for an immediate refund . . . no questions asked.  The product will be sent Via UPS or USPS Priority mail within 24 hours of receiving your order. (Please be sure to enter a physical mailing address. If you enter a PO Box, your product will be sent by regular post and can take up to 2 weeks to arrive)

 

Name:__________________________________________________________

Company (optional):________________________________________________

Address:_________________________________________________________

City:____________________________________________________________

State:___________________________        Country:______________________

Zip:______________________         Phone:(_______)_____________________

Email:___________________________________________________________
(double check spelling as this is the email confirmation you will receive after purchase)

Select Product:
Qty Item Code $
___ PRD0001 29.97 (1 bottle)
___ PRD0002 59.94 (2 bottles)
___ PRD0003 89.91 (3 bottles)
___ PRD0004 119.88(4 bottles)
 
Qty Item Code $
___ PRD0005 $149.85    (5 bottles)
___ PRD0006 179.82   (6 bottles)
___ PRD0007 45.94   (OneMin-Dental)
___ PRD0008 121.85   (2-OneMin-Dental+ 2 bottles)
___ PRD0009 15.95   (1-Oral Irrigator)

Select Shipping Preference:
  US domestic: $6.00
(   US Post Office Priority Mail (US only) : $6.00
(   ) US Post Office Express Mail ( US only) : $35.00
  UPS Ground ( US only) $11.00
  International:  
(   ) US Post Office Global Priority Mail: $7.95
(   ) US Post Office (Domestic) Express Mail (Global, Tracking # - OK ): $20.00
(   ) US Post Office (International) Express Mail (Global, Tracking # - OK ): $35.00
  ( 2 - 3 business days)
  
     
(   ) UPS ( 2 - 3 business days) (Global): $56.00
(   ) DHL( 2 - 3 business days ) ( Global): $56.00
(   ) FedEx ( 2 - 3 business days) ( Global): $56.00
Subtotal ________.___
Shipping ________.___
Total amount ________.___

Select Payment Preference:
(     ) I am enclosing a Cashier's check or money order
(     ) I want to charge this purchase to my credit card.
        Check one: __ VISA     __ Master Card     __ American Express     __ Discover

* Please include $0.825 retail sales tax for California resident on your order total.

       Card Number:__________________________________________________

       Name on card:__________________________________________________

       Expiry Date:____________________________________________________

        Signature______________________________________________________