GHR1000 and IGF1-RX - Mail Order Form

Special Offer: GHR1000 and IGF1-RX™ - Mail Order Form

Please print this form, enter the required information and mail to:

Austin Research Institute
Order Dept # GHR/IGF
P.O. Box 922
Hampstead, MD 21074
USA

The following are special pricing options for GHR1000/IGF1-RX™ (please circle one):

Only $125.42 total cost: (1) bottle of GHR1000 + (1) bottle of IGF1-RX™
Only $209.41 total cost: (3) bottles of GHR1000 + (1) bottle of IGF1-RX™
Only $277.45 total cost: (5) bottles of GHR1000 + (1) bottle of IGF1-RX™ (MOST POPULAR)
Only $357.44 total cost: (7) bottles of GHR1000 + (1) bottle of IGF1-RX™
Only $437.43 total cost: (9) bottles of GHR1000 + (1) bottle of IGF1-RX™
Only $517.42 total cost: (12) bottles of GHR1000 + (1) bottle of IGF1-RX™ (OUR BEST VALUE)

      All prices are in U.S. Dollars.  Limit 1 bottle of IGF1-RX™ per order.
      Each bottle of GHR1000 contains a 30 day supply.  Each bottle of IGF1-RX™ contains a 28 day supply.

PAYMENT OPTIONS

  We accept the following forms of payment (U.S. funds only):

cash

money orders

cashier's checks

  Note: We do not accept personal checks or COD's.

  Please make your money order payable to: Austin Research Institute

CUSTOMER SHIPPING INFORMATION

  FULL NAME: ____________________________________________________

  STREET ADDRESS: _______________________________________________

  CITY, STATE, ZIP: _______________________________________________

  COUNTRY/PROVINCE: ___________________________________________

  TELEPHONE NUMBER: ___________________________________________

  EMAIL ADDRESS: ______________________________________________

  Note: Your daytime telephone number is needed in the event that FedEx has to contact you regarding delivery. Your email address is needed in the event that we must contact you regarding your order. All of your information will remain completely confidential and will not be sold or given to anyone. Maryland residents please add 6.0% sales tax. All prices are in U.S. Dollars.

AGE VERIFICATION

  I hereby certify that I am at least 18 years of age.

  CUSTOMER SIGNATURE: ____________________________________________

MAIL THIS COMPLETED FORM (WITH PAYMENT) TO:

Austin Research Institute
Order Dept # GHR/IGF
P.O. Box 922
Hampstead, MD 21074
USA

In most cases, your order will be shipped within 48 hours of receipt of payment.