Product Of The Month Order
South Africa Only
If there is a problem when you submit the form, just click here and type the products that you need.

 Proof of purchace

Provide your ordering information:

1. Choose the following options:
   ctrl select for multiple selection
   Homecare - R 306.00 Weight Loss Vanilla Pack - R 715.00 Weight Loss Chocolate Pack - R 715.00 Herbal Range - R 785.00 Skincare - R 470.00 Personalcare - R 290.00

   Extra information that you need
   and order quantity if more than 1 each
    

   Payment :    Cash Into Bank Account
   (Banking details will be given after confirmation of order.
   Then fax Copy of payment to 083 118 461 4226 or email to gnldbloem@webmail.co.za)

   Enter the estimated date for delivery (allow 4 - 5 working days)
   -- dd/mm/yy
   after confirmation of payment

   Method of collecting	Street Address (anywhere in South Africa)      R 60.00  delivering cost
   	Bloemfontein DSC              No Delivery Cost
   Language	English      Afrikaans
   Name and Surname
   Title
   Organization	if applicable
   Street  Address
   Address (cont.)
   City
   State/Province
   Zip/Postal Code
   Country
   Currency
   Work Phone/Cell no
   Code
   Home/Celluler Phone
   Code
   FAX
   Code
   E-mail
   Contact Person

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