Retail & Smart Shopper Product Order Form
**Live a SomaLife**

SomaLife Health Products, Inc. Customer Service 1-877-256-7662
Suite A, 3260 East Johns Prairie Rd, Shelton, WA, 98584, USA Fax 1-877-247-7662
Ordered By: ID # Date:
Shipping Address: City: Prov/State:
Postal/Zip Country: Work Ph.#:
email address:   Home Ph.#:
Enroller and Sponsor Information
"Sponsor" is the person who signed you up.
Enroller/Sponsor: Sponsor Phone: Sponsor ID:
Retail Purchase Only SomaLife gHP (180 tablets) Retail Price $125.00     1 $125.00 $143.64
Smart Shopper Application and Purchase

SomaLife gHP (180 tablets) Smart Shopper Price $105.00

1. I understand that monthly auto-ship is an option, and that my auto-ship order (AMO), can be changed at any time by informing SomaLife Health Products Inc. at least 5 business days before my regularly scheduled Auto-ship date of the 5th, 12th, 20th, or 26th of the month specified.
2. I understand that my Auto-ship order will be shipped to me after I have authorized SomaLife Health Products Inc. to debit my MC/VISA/ AM EX/. This authorization will remain in effect until canceled by me in writing.

SomaLife Health Products Inc. - TERMS AND CONDITIONS

I confirm that I am the age of majority in the location in which I intend to market the Company’s products. I agree to be bound by the Company’s Policies and Procedures as amended from time to time and I acknowledge it is my responsibility to keep up to date and use current forms to conduct my Independent Distributorship Business.

    1 $105.00

$122.25 first order shipped immediately,

and $122.25 each

5th, 12th, 20th, 26th


Jan, Feb,
Mar, Apr,
May, Jun,
Jul, Aug,
Sep, Oct,
Nov, Dec

Credit Card #
Name on Credit Card

All prices in Canadian $. Shipping and Handling charges are subject to change.

Last Updated 2002.04.24 cm

You may also phone or fax this order at the numbers above.