RETAIL PRODUCT
ORDER FORM
Please enter all the information below to generate a printable purchase order to fax to us.

Item Code
Description
Price
Quantity
Total
1001
StemEnhance Single
$59.95
1001a*
StemEnhance Single ASP
$49.95
 
Shipping & Handling Charges
 
Check if you are a resident of the United States
(5% of order, USD $5.95 min)
 
Check if you are a resident of AK, HI, PR
(5% of order, $7.95 min)
 
Check if you are a resident of Canada
(8% of order, $11.95 min)
 
  Please enter your local  Sales Tax Rate (Exemptions may apply)
% (if applicable)
 
Total invoice charge will be calculated after submitting this form  
Sales Tax Exemptions
The following states do not charge any sales tax: ...............................AK,DE,MT,NH,OR
The following states to not charge any sales tax on nutritionals: ......AZ,CT,FL,LA,MD,MI,NJ,NY,OH,PA,TX,VT
The following states do not charge any sales tax on S/H: ....................AL,AZ,CA,ID,IA,KY,MA,MD,ME,NJ,OH,VT,VA,WI
*YES, please sign me up for StemTech's AutoShip program. I understand that StemTech will send me the products I select each month and I authorize StemTech to charge my credit card for each monthly order. I undestand that I may cancel my AutoShip at any time.

Ship To:  
Full Name
Address
City
State Zip
Phone
 
Email  Address
Independent Distributor Referred By
ID Number 
Payment Method: (Please check one)
Please check one: VISA MasterCard AMEX Discover
Cardholder Name:
(as appears on card)
Credit Card Number:
Expiration Date: Ex: 09/2007
Total Charges: Calculated on final printable page
***Signature Required on final purchase order.

You, the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.

For Faster Service:
Online Orders > Click to view online order form
Fax Orders > (949) 542-8617
Phone Orders > 888-StemTech (credit card only)
Mail Orders:
StemTech HealthSciences, Inc.
1011 Calle Amanecer, San Clemente, CA 92673
30-Day 100% Money Back Guarantee