FHCi HPx Promotional Supplies Order Form

This form is to purchase additional promotional supplies such as HPx brochures or postcards. Please submit the quantity that you would like to order. Select the number of items shipped.

Less than 100 items shipped will be $8, more than 100 items shipped will be $13.50.

Business cards are .15cents each, all other items are .20cents each plus shipping.

Name*

First NameLast Name

Your Email*

example@example.com

Your Phone Number*

Please enter a valid phone number.

Shipping Address*

Street Address

Suite/ Apt. Number

CityState / Province

Postal / Zip Code

My Products

HP Brochures - indicate quantity, .60 cents each

$6.00

	Quantity	Price
10 Brochures		$6.00
25 Brochures		$15.00
50 Brochures		$30.00
100 Brochures		$60.00

Item subtotal:$0.00

Yellow Fever Cards - indicate quantity, $1.00 each

$5.00

	Quantity	Price
5 Cards		$5.00
10 Cards		$10.00
15 Cards		$15.00

Item subtotal:$0.00

Individual HPx Program Cards, .20 cents each Product Image

Individual HPx Program Cards, .20 cents eachPlease enter quantity as 1 for FIVE cards, 2 for TEN cards, 3 for FIFTEEN cards.

$1.00

	Quantity	Price
Healthy Biome HPx		$1.00
Full Childhood Immunological HPx		$1.00
Young Adult and College Prep HPx		$1.00
Healthy Travel HPx		$1.00
Healthy Sexuality and Pre-Procreation HPx		$1.00
Group B Strep HPx		$1.00
Healthy Pregnancy and Fetal Development		$1.00
Immune Health for Elders		$1.00
Seasonal HPx		$1.00
Tick Borne Illness		$1.00
Single Disease Prevention HPx		$1.00
Influenza		$1.00
Pneumonia		$1.00
Measles		$1.00
Chickenpox		$1.00
Whooping Cough		$1.00

Item subtotal:$0.00

Circle of Disease Cards - indicate quantity, .20 cents each

$5.00

	Quantity	Price
25 Cards		$5.00
50 Cards		$10.00
100 Cards		$20.00

Item subtotal:$0.00

Education Cards - indicate quantity, .20 cents each

$5.00

	Quantity	Price
25 Cards		$5.00
50 Cards		$10.00
100 Cards		$20.00

Item subtotal:$0.00

Business Cards - indicate quantity, .15 cents each

$3.00

	Quantity	Price
20 Cards		$3.00
50 Cards		$7.50
100 Cards		$15.00

Item subtotal:$0.00

ShippingFor less than 100 items, please select $8 shipping. For more than 100 items, please select $13.50 shipping.

$8.00 Quantity
Item subtotal:$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.