Justisse Healthworks for Women Order Form

  
 
Product Quantity Price (CAD)
Justisse Method User’s Guide   $12.00
Justisse Method User’s Kit (User’s Guide, 6 cycle charts, coloured dots)   $22.00
User's Kit with glass/mercury thermometer   $29.00
User's Kit with digital thermometer   $39.50
Coming Off the Pill, the Patch, the Shot and other Hormonal Contraceptives: Learning How to Restore Menstrual Cycle Health   $20.00
Justisse menstrual cycle charts: mucus only   3 for $5.00
Justisse menstrual cycle charts: mucus & temperature   3 for $5.00
Justisse menstrual cycle charts: special situations   3 for $5.00
BBT thermometer glass & mercury   $7.00 each
BBT thermometer digital   $17.50 each
Coloured dots for charting menstrual cycles events   600 for $3.50
     
Subtotal:    
Postage and Handling 10%:    
G.S.T.:    
Total:    

Ship To (Name):
Company:
Address
City:                                                                                 Province/State:
Country:                                                                          Postal Code/Zip:
Phone:                                                                             E-mail:

Bill To: same as ship to (complete "bill to" section, if different from "ship to")

Ship To (Name):
Company:
Address
City:                                                                                 Province/State:
Country:                                                                          Postal Code/Zip:
Phone:                                                                             E-mail:

Method of Payment

____ Payment Enclosed (check or money order made payable to Justisse-Healthworks)

____ MasterCard

____ Visa

CARD NUMBER __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __     Expiration date __ __- __ __             

PRINT Cardholder’s Name                                                             Signature