Please fill out this form and mail to:

YourMenopauseType®com, Inc.
8690 Stone Harbour Loop
Bradenton FL 34212
Tel: 941-749-5105

International Order Form - Also can be used for Yearly Renewal

This form is for international orders only (Outside of the United States)

A money order or cashier check in US funds is required.

Please enclose check or money order and make payable to: YourMenopauseType.com, Inc.

Name of Program

Cost

Management of Menopause Type® Program

(Does not include Lab Test)

$195.00

Yearly renewal is same price of (Does not include Lab Test) $195.00

 

Total

 

 

Name:

 

 

 

 

 

Business:

 

 

 

 

 

Address:

 

 

 

 

 

City:

 

 

 

 

 

State:

 

 

 

 

 

Zip Code:

 

 

 

 

 

Country:

 

 

 

 

 

Telephone:

 

 

 

 

 

E-Mail:

 

 

 

 

 

Password:

 

 

 

Please choose a password of 4 or more letters or numbers. This password will be used for entry into the Management of Menopause Type® Program.
We will send you an E-Mail telling you when your password has been activated so you may have immediate access.

 

 

Thank You

 

Home