Mail / Fax Order Form
*Print this page, fill out all information, and send this form by mail or fax to:

Prime Life Nutriceuticals / TheraStress
165 Castilian Dr
Goleta, CA 93117

FAX: 805-681-8201

Name:

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Money Order / Cashiers Check (Payable to Prime Life Nutriceuticals in US$ only)

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Buy 2 Bottles of TheraStress™ Get 1 Bottle Free

Buy 3 Bottles of TheraStress™ Get 3 Bottles Free

Buy 6 Bottles of TheraStress™ Get 6 Bottles Free

Single Bottle of TheraStress™

Subtotal:

$.

Shipping (US orders $9.95, international orders $24.95)

$.

Grand Total:

$.

(For California residents, tax will be added to your order)