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Secure Order Form 
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Just follow the easy steps.

FOR RETAIL go here:

FOR WHOLESALE go here:

To Use our Toll Free PHONE Ordering system click here!
To Use our FAX or US MAIL order form click here!

About Secure Orders     About Privacy


 
 
Retail - Step 1: 

TAHITIAN NONI® Juice - Dietary Supplement
All funds are US.   Please send ME . . .


Product Description: Quantity
Total Price
TAHITIAN NONI®   Juice (33.8oz.) - Bottle @ $42.00 ea.
TAHITIAN NONI® Juice - Case
 @  $168 ea. case (4 bottles per case) 
Subtotal:  
Shipping:
7.54% of subtotal. $7.75 min.
add
Sales Tax:
Sales tax is required in all states except in the following:CT,DE,DC,FL,MD,MI,MN,
MT,NH,NJ,NY,OR,PA,PR,WI,VT.
Sales tax calculated on Subtotal is added here.
     
TOTAL:  

(please calculate amounts)(International orders please email first)

GO TO PAYMENT AREA NEXT
 
 
 
 
 
 

Wholesale - Step 1:

TAHITIAN NONI® Juice - Dietary Supplement
All funds are US.   Please send ME . . .


Product Description: Quantity Total Price
Wholesale Buyer Startup Kit 
(required for wholesale price)  @ $35.00 
1 $35.00
TAHITIAN NONI® Juice - Case @ $128 ea. case wholesale
 (4 bottles per case) if on autoship then only $120 ea.
Subtotal:  
Shipping:
7.54% of subtotal. $7.75 min.
add
Sales Tax:
Sales tax is required in all states except in the following:CT,DE,DC,FL,MD,MI,MN,
MT,NH,NJ,NY,OR,PA,PR,WI,VT.
Sales tax calculated on Subtotal is added here.
     
TOTAL:  

Additional Information required for Wholesale Buyers


Birthdate:
Social Security No#:
(required for taxes)
Would you like to have the 
benefits of case autoship?
Yes  No

 continue below to payment



 
 
 

Payment - Step 2: 

Please provide the following contact information:
(ALL information is required to process order)


Billing Address:  
First name
Last name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
 
 
Credit Card - Step 3:

Please provide the following ordering information:

 
  BILLING
Credit card
Cardholder name
Card number
Expiration date
  SHIPPING ADDRESS
  If same as billing address, check here
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Would you like to request something not listed here or ask a question?
Use this area to make comments or requests. This is a good area to provide
 us with information on any health concerns you are dealing with. All information is strictly confidential.

Please take some time to double check your order for completeness.
Please allow 7-10 days to receive your products.

 - Thank you

By pressing the Send Order button below you authorize Morinda Inc.
 to bill your credit card as listed above. You must be an
authorized user of the credit card in order to place this order.

Problems with order form email here for help or call 609-397-3808


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Copyright 2000 - Breath Awareness Center 
26 Bridge St. Lambertville, NJ 08530
609-397-3808