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Order Form
Sponsors Name: Sponsors Name Here
Sponsors Username: Sponsors Username Here
Order Information
Username:
(Min Characters per Username 4, Max 15)
First Name:
Last Name:
Address:
Address 2:
City:
State:
Zip/Postal:
Country:
Email Address:
Phone:
Order
Select
ONE
of the following
(Shipping, Taxes and Biz Opp Not Included in Price)
Silver
(
1
iTeraCare
Classic
)
USA: $380
Canada: $385
Australia: $420
QTY:
1
2
3
4
5
6
7
8
9
Gold
(
3
iTeraCare
Classic
)
USA: $1,140
Canada: $1,145
Australia: $1,260
QTY:
1
2
3
Diamond
(
10
iTeraCare
Classic
)
USA: $3,800
Canada: $3,735
Australia: $4,200
Diamond
(
1
iTeraCare
PRO
)
USA: $3,800
Canada: $3,735
Australia: $4,200
Submit Order Form