Mail Order Form International

Send To Printer

Prices are listed in U.S. Currency.
There is an online currency converter here: http://www.xe.com/ucc/
We accept checks, international money orders, and bank drafts.

We will send you an email confirmation as soon as your order ships.
Ship To Information:

Name:

Address 1:
Address 2:

City:

State:

Zip Code:

Telephone:

Email address:
How did you hear about us?

Yahoo Google Banner
TV Doctor Magazine
Radio Word of mouth Email
Other: ___________________________
Order Information


I would like to order:

(price includes $14.95 shipping)

1 bottle of Vilantae Capsules.....$64.90

2 bottles of Vilantae Capsules.....$114.85

3 bottles of Vilantae Capsules.....$164.80


1 bottle of Vilantae Powder.....$64.90

2 bottles of Vilantae Powder.....$114.85

3 bottles of Vilantae Powder.....$164.80

Other: Please specify and add total below:






(please write in and calculate total if ordering more than 3 bottles, or if you would like to order a different product.)
Shipping is a flat $14.95 regardless of order size.

We will send you an email confirmation as soon as your order ships.

Please print this page and mail with
check or money order to:

Evolution-X Inc.
919 Conference Drive
Suite 4 # 276
Goodlettsville, TN 37072


Checks should be written out to Evolution-X. Delivery generally takes 3-4 days from the time we receive your order form.