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Order Form for...

“The Definitive Rid Yourself of Arthritis Pain & Stiffness Package”
.

We are pleased to offer 2 alternative payment options for your convenience...

Visa or Mastercard via our Merchant account; or
Personal Check and Money Order option

To confirm, you will receive the entire package
as outlined below for the one-time cost of $59.94 USD

Credit Card Order Form:
Definitive Rid Yourself of Arthritis Pain & Stiffness Package - $59.94USD

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Home Phone*
Home Phone*

Full Name on Your Card:*
Full Name on Your Card:*

Type of Credit Card:*
Type of Credit Card:*

	Visa
	Mastercard

Credit Card Number*
Credit Card Number*

Expiration date (Month & Year)*
Expiration date (Month & Year)*

CCV # (Last 3 digits on back of card)

Please enter the word that you see below.

ALSO: We will accept your Check or Money Order made out as follows:

Payable to:            Pebal Ventures
Amount:            $59.94 USD
Mailing address:    17 Hall Avenue

                            Guelph, Ontario
                            N1L 0B3
                            Canada

Please note that:

For physical products, your package will be shipped within 48 hours of us confirming payment.

For downloadable products, instructions for accessing your package on-line
will be sent immediately after payment confirmation via an
email that is sent to your provided email address.