Drink Order Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Which batch are you ordering for?

Select your pickup day: Sunday Batch

Select your pickup day: Wednesday Batch

Select your pickup time:

My Products

🍍 Pineapple Mint Cleanser (16 oz)

Pineapple

Cucumber

Apples

Fresh Mint

Lemon

$12.00 Quantity

🥬 Green Lymph Flow (16 oz)

Celery, Cucumbers, Spinach, Apples, Lemon, Ginger

$12.00 How many bottle

Beet The Boat (16 0z)

Beet

Carrot

Cucumbers

Apples

$12.00 Quantity

Green Glow

Debloat + Lymph Flush)

Ingredients:

2 cucumbers

4 celery stalks

1 green apple

1 lemon

handful mint

small piece ginger

$12.00 Quantity

Golden Skin Glow

(Skin + Gut Repair)

Ingredients:

3 carrots

1 orange

1 cucumber

1 lemon

small turmeric root

small ginger root

$12.00

Bundles

3-Day Glow Reset— 3 day/6 juices

6 bottles + guide

Green Glow, Golden Skin Glow, Snatch Me

$85.00 Quantity

🧃RESET + 🧠RESTORE + 🌱 REBALANCE

7 days/14 juices

$146.00 Quantity

🧃RESET + 🧠RESTORE

5 days/10 juices

$110.00 Quantity

🧃RESET

3 days/6 juices

$85.00 Quantity

Total

Pickup Location Agreement (Required Checkbox):

PAYMENT INSTRUCTIONS:

After submitting this form, send payment to secure your order:

💸 Zelle / Apple Pay: 7542219094

⚠️ Orders are ONLY confirmed after payment
⚠️ No payment = no juice reserved

You will receive a confirmation message once payment is received.

Want to be notified when batches sell out or new juices drop?

Notes

Juice Order Form

My Products