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Sample Request Page





To receive FREE samples of our products,
please fill out the complete form and hit SEND!
( * Required before sending.)

Name: *
Gender:
Age:
Street: *
City: *
State: *
Zip Code: *
Country: *
Phone: *
ICQ #:

Any Medical Problems YES NO

If you answered YES then explain what medical problems:

I WOULD LIKE TO LOSE:(select one)

Please tell me a little about yourself!


Do you have a friend or loved one that
needs to get healthy? Send them this page by putting their email
in the box below.


When you hit the send button, a browser box will pop up telling
you a warning. This is just letting you know that your
are sending a form to me with your email address on it .
Click "OK" and then click send.


Your information will be kept confidental, and your samples will
be mailed to you in 8 to 10 days
Thank you for your time and hit the send button when every
question is filled out!

Also it has come to my attention that about 20% of request
are not making it back to me due to
and error in my mail server and this form.
As a extra step, please also send me a blank email to let me know your
requesting these samples.
I want to make sure your getting through to me!
Click on my name below to send the blank email! Thanks!

Email: Brian Shanks





Email: Brian Shanks


Or call TOLL FREE
1-877-652-7952

My ICQ Number Is:
41772416