Dr. Orman's Hgh Plus® Order Form

For those who wish to pay via Check or Money Order, please print this page and mail with payment.

Name:__________________________________________________

Mailing Address:_________________________________________________

City:__________________     State:______   Postal Code:_________

Phone:________________

Number of Bottles:_________

• 1 bottle = $69

• 3 bottles = $189*

• 6 month Autoship = $60/mo.*

• 12 month Autoship = $55/mo*

* = Additional benefits included. The above costs do include shipping and handling.

Special Instructions:___________________________________________

Please make checks payable to Diana Castillo:

DMI

c/o Diana Castillo

2246 Misthaven Lane

Gambrills, MD  21054  USA

Thank you.