QLife® ORDER FORM

Price List :

ITEM No. 1: QLIFE® Melatonin 3-mg Tablets, 60/bottle ($5.00)
ITEM No. 2: QLIFE® DHEA 25-mg Capsules, 60/bottle ($6.00)
ITEM No. 3: Super Anti-Oxidant II, Capsules, 60/bottle ($16.50)
ITEM No. 4: Multi-Vitamin with Minerals, Tablets, 90/bottle ($13.00)
ITEM No. 5: Gingko Biloba 60-mg Capsules, 60/bottle ($8.50)
ITEM No. 6: St. John's Wort 300-mg Capsules (w/25 mg Gingko Biloba), 60/bottle ($8.50)
ITEM No. 7: Vitamin E NATURAL 400-iu Capsules, 100/bottle ($13.00)
ITEM No. 8: Vitamins A&D 10,000-iu A - 400-iu D Capsules, 100/bottle ($4.00)
ITEM No. 9: Book: "DHEA. The Fountain of Youth Discovered" by Alana Pascal($5.00 USA, $6.00 Canada, $7.00 Europe, $8.00 Asia/Africa/Australia - shipping cost included.)
ITEM No. 10: ARONMAG® (Magnesium with Aronia Berry Extract, 27 mg Mg) Coated Tablets, 60/unit ($6.00)
ITEM No. 11: AZARINA® (Extracts of Asarum, Celandine, Anise, and Licorice ) Tablets, 10/unit ($7.50)
ITEM No. 12: BOLDALOIN® (Extracts of Aloe and Peumus boldus) Tablets, 30/unit ($6.00)
ITEM No. 13: CYNAREIN® (Extracts of Cynara, Rhei Root, and Celandine) Coated Tablets, 30/unit ($8.00)
ITEM No. 14: RHEUM Root Tablets, 10/unit ($4.00)

SHIPPING METHOD & HANDLING CHARGE SCHEDULE (in US$)
Select destination and shipping type by choosing choice next to destination and mail type:

pping and Handling Cost Table
No. of Units Ordered => DESTINATION	1 - 4	5 - 8	9-12	Select Destination
Contiguous United States (First Class Mail)	free	free	free
United States (AL, HI, PR or Priority Mail)	5.00	6.50	8.00
Canada and Mexico	5.00	7.00	9.00
Australia, Japan, and New Zealand	9.00	15.00	18.00
ALL OTHER COUNTRIES	8.00	13.00	16.00

Please contact us via e-mail or fax if you wish to order more than 12 units or request an express delivery.

QLIFE® PRINTABLE ORDER FORM
Page 2 (to be sent via FAX or with mail orders: PLEASE TYPE IN THE PARTICULARS OF THE ORDER)

Item No.	Item Description	Strength in mg	Quantity	PRICE





		SUBTOTAL
	PLEASE REFER TO TABLE ABOVE FOR SHIPPING CHARGES	SHIPPING
		GRAND TOTAL

(Ceci ne regarde pas les etrangers. Questo non riguarda i stranieri.)
Please be advised that we must add 8.0-% sale tax for any New York State destination

*SHIP TO:*
Name
Address
City	State ZIP
Country
Phone (in case there's a problem)
E-mail (we may need it to contact you about the order)

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CREDIT CARD ORDER INFORMATION

    Credit Card    Cardholder's Name    
    Card Number  Expiration Date (month/year) /

By checking here, you are authorizing us to bill your credit card for the merchandise specified.
At the same time, you are also stating that the credit card account above is yours, or that you have been specifically authorized to use the card for this purchase.

Signature Required on printed forms: ____________________________________

How did you find us

QLIFE® PRINTABLE ORDER FORM (please fax or mail this form)

If ordering with a credit card, please fill in the blanks and print out this form. Fax to (973) 633-8410 (USA).
Another option: enclose a check (travelers check is OK) or money order in US$, and mail to:
BATORY A.M., Inc., P.O. Box 275, Lincoln Park, NJ 07035-0275 (USA)

If paying by check/money order: please make sure the check or money order, made out to BATORY A.M., Inc., is in US$ and payable through a US-based bank.
INTERNATIONAL CUSTOMERS: Travelers Checks are convenient, secure, and inexpensive method of payment by mail.
If this is your preference, please send us Travelers Check(s) in US$ (countersigned and made payable to Batory A.M., Inc.).
Money Back Guarantee:
US and Canadian Clients receive full refunds (minus S&H) upon written request (fax or e-mail are OK). Other Clients: refund for any unused portion minus shipping and handling costs upon return of the unused portion to us via mail.

PLEASE REFER TO TABLE ABOVE FOR SHIPPING CHARGES

(Ceci ne regarde pas les etrangers. Questo non riguarda i stranieri.) Please be advised that we must add 8.0-% sale tax for any New York State destination

By checking here, you are authorizing us to bill your credit card for the merchandise specified. At the same time, you are also stating that the credit card account above is yours, or that you have been specifically authorized to use the card for this purchase.

(Ceci ne regarde pas les etrangers. Questo non riguarda i stranieri.)
Please be advised that we must add 8.0-% sale tax for any New York State destination

By checking here, you are authorizing us to bill your credit card for the merchandise specified.
At the same time, you are also stating that the credit card account above is yours, or that you have been specifically authorized to use the card for this purchase.