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• To order, you may fill in the Online Order Form and hit send. You may also print out the form and fax or mail it to us with your payment. Personal check is also accepted. (Please make check payable to Aloha Holistic Clinic.)

*** For International Orders ***

• Shipping charges will be added to your credit card.

• International Orders that are detained or confiscated by Customs are not subject to refund. We suggest that you contact your Customs authorities and inquire if you have a concern about a particular product.

Online Order Form
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Name:
Address:
City:	State:ZIP:
Country:
Phone:	Fax:
E-mail:
Payment:
Credit Card:	Visa American Express Master Card
Card Number:	(Don't include spaces between numbers)
Expires:	Month: 01 02 03 04 05 06 07 08 09 10 11 12 Year: 2003 2004 2005 2006 2007 2008 2009 2010
Name on Card:
Item#	Product	Each	Qty	Total
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