Special Offer: Z-tropin™ and GHR1000 - Mail Order Form



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

Austin Research Institute
Order Dept # SPC-ZTR
P.O. Box 922
Hampstead, MD 21074
USA



ORDER SIZE OPTIONS

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

      Maryland residents please add 6.0% sales tax.  All prices are in U.S. Dollars.  Limit 3 bottles of GHR1000 per order.
      Each bottle of GHR1000 contains a 30 day supply.  Each bottle of Z-tropin contains a 60 day supply.



PAYMENT OPTIONS

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

      Note: We do not accept personal checks or COD's. All prices are in U.S. Dollars. We only accept U.S. Funds.


  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.


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 # SPC-ZTR
P.O. Box 922
Hampstead, MD 21074
USA


In most cases, your order will be shipped within 24 hours of receipt of payment.

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