Online Spring Water Supreme

Clean Water Additive

Spring Water and Bottled Water

Order by Mail:

Print this form, fill it out, and mail it along with a check or money order to the address below:

 

Name____________________________________________________________________________      

Address__________________________________________________________________________   

City___________________________________________   State_________   Zip_______________ 

Phone #________________________________   Evening # _______________________________ 

 

Item 

Price

Subtotal

Product #21231:  1 Bottle (16.9 oz.) of Spring Water Supreme.

$ 39.95

$

Product #21232:  2 Bottles of Spring Water Supreme.

$ 74.95

$

Product #21233:  3 Bottles of Spring Water Supreme.

$ 99.95

$

Add USPS Overnight Express Mail on any of the above. 

$ 15.00

$

Add Global Express shipping and handling to Canada.

$ 25.00

$

Add Global Express shipping and handling to all other International destinations.

$ 35.00

$

.

.

.

.

TOTAL

$

 Orders received with a Postal Money Order are shipped the same day.  Personal checks might take as long as five days to process.  Mail to:

21st Century Health
100 Glen Street #2326
Glen Cove, NY 11542

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