U.S. Mail Order Form
Send To Printer
Ship To Information:

Name:

Address 1:
Address 2:

City:

State:

Zip Code:

Telephone:

Email address:
How did you hear about us?

Yahoo Google Banner
TV Doctor Magazine
Radio Word of mouth Email
Other: ___________________________
Order Information


I would like to order:

(price includes $6.95 shipping)

1 bottle of Vilantae.....$46.90

2 bottles of Vilantae.....$86.85

3 bottles of Vilantae.....$126.80

1 bottle of Vilantae
and 1 COLD FUSION acne treatment
.............................$76.85

Other: Please specify and add total below:






(please write in and calculate total if ordering more than 3 bottles, or if you would like to order a different product.)
Shipping is a flat $6.95 regardless of order size.
We will send you an email confirmation as soon as your order ships.

Please print this page and mail with
check or money order to:

Evolution-X
2700 South Roan Street #440
Johnson City, TN 37601

 Checks should be written out to Evolution-X. Delivery generally takes 3-4 days from the time we receive your order form.