Bio Health Australia - Product Order Form

Product Order Form

Nourishing You, The Bio Health Australia Way
Customer's Information
Customer's Name*

First NameLast Name
Phone Number*

Country CodeArea CodePhone Number
Email Address*
example@example.com
Delivery Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Member Number
Enter your Membership ID number
Do you have a referral code from your practitioner?

NoYes
Referral Code:
Enter the referral code provided by your practitioner
Order Details
Order Date*

DayMonthYear
Date
Products (Pricing incl GST)*
prevnext( X )
FenBen 500mg90 Veggie Capsules
$98.00AUD Quantity
Item subtotal:$0.00AUD



FenBen MSM 500mg90 Veggie Capsules
$98.00AUD Quantity
Item subtotal:$0.00AUD



Vitamin D3 50,000iu90 Fish Gelatin Softgels per bottle, each contains 50,000 IU
$68.00AUD Quantity
Item subtotal:$0.00AUD



GlyNAC60 Veggie Capsules
$92.00AUD Quantity
Item subtotal:$0.00AUD



Cell Resurrection 60 Veggie Capsules
$92.00AUD Quantity
Item subtotal:$0.00AUD



Liver Resurrection60 Veggie Capsules
$68.00AUD Quantity
Item subtotal:$0.00AUD



Immune Resurrection60 Veggie Capsules
$65.00AUD Quantity
Item subtotal:$0.00AUD



Brain Resurrection™60 Veggie Capsules
$92.00AUD Quantity
Item subtotal:$0.00AUD



Vitamin E Succinate60 Gel Capsules
$58.00AUD Quantity
Item subtotal:$0.00AUD



Total

$0.00AUD
Sending International (ex AU)?*

NoYes
Total Items Shipping within Australia*

1-2 Items - $11.15 AUD (1 x Sml)3-8 Items - $15.25 AUD (1 x Med)8-12 Items - $19.30 AUD (1 x Lge)13-25 Items - $23.30 AUD (1 x XLge)
If you’d like to order more than the quantities listed on this form, we’ll be in touch to confirm any updated shipping costs before finalising your order.
International Destination (Australia Post Zone)*

New Zealand (Zone 1)China (Zone 2)USA / Canada (Zone 3)UK / Ireland (Zone 4)
Total Items Shipping to Zone 1, Band 0 - New Zealand*

1-2 Items - $16.30 AUD (Up to 250g)3-8 Items - $19.65 AUD (251g to 500g)8-12 Items - $26.40 AUD (501g to 1kg)13-25 Items - $33.15 AUD (1.001kg to 1.5kg)26-35 Items - $39.90 AUD (1.501kg to 2kg)
Total Items Shipping to Zone 2, Band 0 - China*

1-2 Items - $19.95 AUD (Up to 250g)3-8 Items - $26.00 AUD (251g to 500g)8-12 Items - $38.15 AUD (501g to 1kg)13-25 Items - $50.30 AUD (1.001kg to 1.5kg)26-35 Items - $62.45 AUD (1.501kg to 2kg)
Total Items Shipping to Zone 3, Band 0 - USA & Canada*

1-2 Items - $22.30 AUD (Up to 250g)3-8 Items - $29.00 AUD (251g to 500g)8-12 Items - $42.20 AUD (501g to 1kg)13-25 Items - $55.55 AUD (1.001kg to 1.5kg)26-35 Items - $68.85 AUD (1.501kg to 2kg)
Total Items Shipping to Zone 4, Band 0 - UK & Ireland

1-2 Items - $27.50 AUD (Up to 250g)3-8 Items - $34.40 AUD (251g to 500g)8-12 Items - $48.30 AUD (501g to 1kg)13-25 Items - $62.15 AUD (1.001kg to 1.5kg)26-35 Items - $76.00 AUD (1.501kg to 2kg)
Is shipping quantity you desire outside of this form's list?

NoYes
Shipping Cost*
Total Cost incl. Shipping*
*At this time, International Shipping will be Quoted
upon receipt of order and destination.
Payment Method

For direct Bank Deposits, please use these details
Bank:	Westpac
Account Name:	BioHealthAU
BSB:	033 609
Account Number:	672561
Reference:	[your name and phone number]

SWIFT Code:	The SWIFT Code for Westpac is WPACAU2S If the sending (your) bank requires 11 characters, use WPACAU2SXXX
Our full 12-digit account number for SWIFT:	033609672561

For credit card payments, we will call for details.

Notes or Special Instructions
Should be Empty:

Product Order Form

Customer's Information

Order Details