Justisse-Healthworks for Women Order Form
1) Email an order form that is filled out with your information to info@justisse.ca
2) Phone us toll free in North America at 1-866-JUSTISSE (1-866-587-8477), and outside of North America at 780-420-0877, to reach the Justisse-Healthworks order desk directly call 1-780-433-7604.
3) Fax an order form that is filled out with your information to 780-433-0481.
4) Mail an order form that is filled out
| Product | Quantity | Price (CAD) |
| Justisse Method User’s Guide | | $13.50 |
| Justisse Method User’s Kit (User’s Guide, 6 cycle charts, coloured dots) | | $25.50 |
| User's Kit with glass/mercury thermometer | | $31.80 |
| 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 | | $6.30 |
| Coloured dots for charting menstrual cycles events | | 600 for $3.50 |
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| 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")
Bill 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: ___________________