| Name _____________________________________ | Phone# ________________________ |
| Billing Street Address¡G ___________________________________________________ |
| City¡G ___________________________ State ¡G ___________________ zip¡G ______________ |
| Ship to Address¡G _______________________________________________________ |
| City¡G ___________________________ State ¡G __________________ zip¡G ______________ |
| Eamil¡G _________________________________________ |
| Credit Card No¡G ____________________________________ |
| Exp date¡G_____(¤ë )_______ (¦~) | Security Code(3-digits-on back of card): _______ |
If you want to pay with a credit card¡Aplease enter your credit card number, expiration date & security code.¡CIf you want ot pay with a chack or money order, please send it with this page to
Natural Healing Plus
3040 S. Hacienda Blvd., Hacienda Hts., CA 91745
Telephone: (562) 429-6888 Fax Number¡G (562) 366-9355 |