Physicians Direct¨

7350 Sandlake Commons Blvd. STE 2217

Orlando, FL 32819

Phone 407-354-0001 Fax 407-363-9538   Phone Order ONLY 1-800-641-2907

Dr. LevineÕs Ultimate Weight Loss Formula $89

 

Select Flavor (place quantity desired on line)

 

____Chocolate ____Vanilla ____Orange Cream #_____ @ $89.00________

 

Shipping and Handling (each) #_____ @ $8.95 _________

Buy Three and Shipping and Handling is FREE*

 

Make check payable to Physicians Direct¨                                 Total $ ______ .___

 

Mail this form with check or credit card info or fax form with credit card info to:

Physicians Direct¨

7350 Sandlake Commons Blvd. Suite 2217

Orlando, FL 32819 Fax to 407-363-9538

 

Name________________________________Email ________________________________

 

Day Phone ________________ Evening Phone________________ Fax________________

 

Address Credit Card Statement is sent to:

 

Name___________________________________Company_______________________(optional)

 

Address_______________________________________________________________________

 

City________________ State________Zip Code_____________________ Country___________

 

Ship To Address if different than above:

 

Name___________________________________Company_______________________(optional)

 

Address_______________________________________________________________________

 

City________________ State________Zip Code_____________________ Country___________

 

Credit Card Information:

 

Type :            qVisa              qMasterCard Visa              qDiscover Visa              qAMEX

 

Name exactly as typed on card: __________________________________________________

 

Card # __________________________________________Expiration Date _______________

 

Visa# last 3 digits on back near signature________________ Amex 4 digits above card#______

 

To learn about "The Best Health Insurance You Can BuyÉ In A Bottle¨"

-visit Physicians Select¨ at www.physicians-select.com (Dr. Levine's Ultimate Antioxidant Formulaª)

To Learn about the ultimate in sun protection -visit Physicians Direct¨ at www.ultimate-skin-care.com

To Learn about the ultimate in antiaging creams-visit Physicians Direct¨ at www.ultimate-skin-care.com

To learn about Depression and St. John's Wort -visit Physicians Direct¨ at www.physiciansdirect.com  

*** Shipping free within the 48 contiguous U.S. States***

 

 

 

 

Physicians Direct¨

7350 Sandlake Commons Blvd. STE 2217

Orlando, FL 32819

Phone 407-354-0001 Fax 407-363-9538   Phone Order ONLY 1-800-641-2907

Dr. LevineÕs Ultimate Antioxidant Formula $79

 

#_____ @ $79.00________

Shipping and Handling (each) #_____ @ $8.95 _________

Buy Three and Shipping and Handling is FREE*

Make check payable to Physicians Select¨                                 Total $ ______ .___

Mail this form with check or credit card info or fax form with credit card info to:

Physicians Select¨


7350 Sandlake Commons Blvd. Suite 2217
Orlando, FL 32819

Fax to 407-363-9538

 

Name________________________________ Email ________________________________

 

Day Phone ________________ Evening Phone________________ Fax_________________

 

Address Credit Card Statement is sent to:

 

Name___________________________________Company_______________________(optional)

 

Address_______________________________________________________________________

 

City________________ State________ Zip Code_____________________ Country___________

 

Ship To Address if different than above:

 

Name___________________________________Company_______________________(optional)

 

Address_______________________________________________________________________

 

City________________ State________ Zip Code_____________________ Country___________

 

Credit Card Information:

 

Type :            qVisa              qMasterCard Visa              qDiscover Visa              qAMEX

 

Name exactly as typed on card: __________________________________________________

 

Card # __________________________________________Expiration Date _______________

 

Visa# last 3 digits on back near signature________________ Amex 4 digits above card#______

 

To learn about The Smartest, Healthiest, Safest, Easiest, and Most Effective Way To Lose Weightª Or Lower Your Cholesterol Naturally -visit Physicians Direct¨ at www.fastweightloss-101.com
To learn about Depression and St. John's Wort -visit Physicians Direct¨ at www.physiciansdirect.com
To Learn about the ultimate in sun protection

-visit Physicians Direct¨ at www.ultimate-skin-care.com
To Learn about the ultimate in antiaging creams-visit Physicians Direct¨ at www.ultimate-skin-care.com  *** Shipping free within the 48 contiguous U.S. States***

 

 

Physicians Direct¨

7350 Sandlake Commons Blvd. STE 2217

Orlando, FL 32819

Phone 407-354-0001 Fax 407-363-9538   Phone Order ONLY 1-800-641-2907

Physicians Direct¨ Dr. LevineÕs Ultimate Anti-aging Cream:  $45.02

 

Quantity ___________  @ $45.02                                                 #_____ @  $45.02  ________

 

Shipping and Handling (each)                                                            #_____ @  $4.95    ________

Buy Three and Shipping and Handling is FREE*

 

Make check payable to Physicians Direct¨                                        Total $ ______ .___

Physicians Direct¨ Dr.LevineÕs Ultimate Sunblock:  $15.04

 

Quantity ___________  @ $15.04                                          #_____ @  $15.04  ________

 

Shipping and Handling (each)                                                            #_____ @  $4.95    ________

Buy Three and Shipping and Handling is FREE*

Make check payable to Physicians Direct¨                                        Total $ ______ .____

Mail this form with check or credit card info or fax form with credit card info to:

Physicians Direct¨


7350 Sandlake Commons Blvd. Suite 2217
Orlando, FL 32819

Fax to 407-363-9538

 

Name________________________________ Email ________________________________

 

Day Phone ________________ Evening Phone________________ Fax_________________

 

Address Credit Card Statement is sent to:

 

Name___________________________________Company_______________________(optional)

 

Address_______________________________________________________________________

 

City________________ State________ Zip Code_____________________ Country___________

 

Ship To Address if different than above:

 

Name___________________________________Company_______________________(optional)

 

Address_______________________________________________________________________

 

City________________ State________ Zip Code_____________________ Country___________

 

Credit Card Information:

Type :            qVisa              qMasterCard Visa              qDiscover Visa              qAMEX

 

Name exactly as typed on card: __________________________________________________

 

Card # __________________________________________Expiration Date _______________

 

Visa# last 3 digits on back near signature________________ Amex 4 digits above card#______

 

To learn about The Smartest, Healthiest, Safest, Easiest, and Most Effective Way To Lose Weightª Or Lower Your Cholesterol Naturally –visit Physicians Direct¨ at  www.fastweightloss-101.com
To learn about "The Best Health Insurance You Can BuyÉ In A Bottle¨" –visit Physicians Select¨ at www.physicians-select.com
(Dr. LevineÕs Ultimate Antioxidant Formulaª)

To learn about Depression and St. JohnÕs Wort –visit Physicians Direct¨ at  www.physiciansdirect.com 

* Shipping free within the 48 contiguous U.S. States.