Product Order Form



To order our products simply print and fill out the form below and then send it with your personal check or money order to: June Konopka, MS, RD, P.O.Box 1328, Fort Collins, CO 80522.  

INSTRUCTIONS: Print out the form below. Select the supplements that you wish to order, sub-total your order, select the appropriate shipping charge, compute sales tax if Colorado resident, and total.

Quantity Supplement Name Count Retail Price Total
Adrena-Plex
100
24.00
B Food Complex
100
22.00
B Food Complex.
250
34.00
Cal-Mag Balance
250
28.00
Flavo-C
100
22.00
FemPlex
100
26.00
GTF Complex
100
24.00
Immune Support
100
24.00
Pro-Min Complex
250
36.00
Supergreens Phytofood
8 oz.
38.00
VasCor
100
24.00
Vita-Liv
100
22.00
Whole Food Complex
250
34.00
 Shipping Charges:

     Order value..... shipping charge
      $ 0 - $ 50........ $ 4.00
      $ 51 - $ 100 ....$ 8.00
      over $100....... $ 10.00
 Those living in Fort Collins may pickup orders.

Sub-Total
$
Sales Tax 6.7%
$
Shipping
$
Total
$


PLEASE PRINT CLEARLY

NAME: __________________________________________________________
ADDRESS: __________________________________________________________
__________________________________________________________
__________________________________________________________
CITY: __________________________
STATE:
_______
ZIP:
____________  
DAY
PHONE: 		_________________ Ext. ________
EVENING PHONE:
_________________

Make out your check or money order to:   June Konopka, MS, RD
Mail check and order form to June Konopka, MS, RD, P.O. Box 1328, Fort Collins, CO 80522



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