| ALWAYS YOUNG® ORDER FORM |
| Mail To | Fax 24 Hours | Phone Orders | | Always Young
827 Route 82, Suite 281
Hopewell Junction, NY 12533 USA | 845.838.8015 | 800.252.8572
845.838.8010 |
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| — DO NOT STAPLE CHECK TO ORDER FORM — |
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BILLING INFORMATION — Required |  If you are paying by credit card, print name and address
exactly as it appears on your credit card statement.
| Name | | Address |
| City | | State | | Zip |
| Country | | Phone |
| E-Mail |
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| | SHIPPING ADDRESS | If different than the Billing Address above. | Name |
| Address | | City | | State |
| Zip | | Country | |
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| | SHIPPING WAIVER | Required for shipping outside the USA | By asking us to ship to a country other than the USA,
you are assuming all liability for any customs, duties, or
tariffs. If customs seizes the shipment, we cannot
refund your payment. | | Waiver agreement must be signed for international shipping. |
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| | | | PRODUCTS | EACH | QTY | Renewal® Advanced | $39.95 | | Renewal® Workout For Men | $39.95 | | Renewal® Power For Women | $39.95 |
| Renewal® IGF-1 | $39.95 | | Renewal® Original | $39.95 | | Food Enzymes | $23.95 | | Essential Fatty Acids | $11.95 | |
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| | Subtotal | $ | Shipping | $ | Total Order | $ |
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| | PAYMENT |
Money orders & checks — payable to Always Young. US funds only. Credit cards accepted:
Visa • MasterCard • American Express • Discover | Card No. | __________________________________
| Exp. Date | __________________________________ | Signature | __________________________________ |
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| | SHIPPING — Check One | USA | _______ | $5.95 | FedEx Ground | USA | _______ | $7.95 | USPS Priority Mail | USA | _______ | $4.95 | APO / FPO – Military Only | USA | _______ | $10.00 | FedEx Express 3-Day | USA | _______ | $14.00 | FedEx Express 2-Day | USA | _______ |
$20.00 | FedEx Express 1-Day | INTL | _______ | $12.00
| USPS Air Mail | INTL | _______ | $20.00 | FedEx International
| INTL – International orders, please sign Waiver. |
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| Thank You for Your Order! |
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| ORDERING INFORMATION | - Please print carefully when filling out the form.
- A day phone number is required in case we need to call about your order.
- Include an
e-mail address if you wish to receive an order confirmation.
| | We accept these credit cards: | - Visa
- MasterCard
- Discover
- American Express
| | We also accept: | - Money order
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Cashiers check
- Company check
- Personal check
| | Payable to Always Young
US funds only |
| For more information or to place a phone order, please call: | | | |
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| PRICING AND DISCOUNTS |
You can calculate pricing on our secure order form. | | | | | | Large Quantities
For large orders, call
for special pricing:
800.252.8572
845.838.8010
Or use our contact form. |
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