Order Form - medifastmedia.com

Step Three: Enter your billing information On Card _____ Phone _____ Address _____City _____ State _____ Zip _____ Step Four: Enter your credit card information below. (Sorry, no checks or CODs. Don t forget to sign and date below.) Visa q MC q Amex q Disc qCredit Card No. _____ Exp. Date _____ Security Code _____Signature _____ Date _____Step Five: Call in orders to (800) 572-4417 OR Fax orders to (443) 471-3319 Prices subject to #Product DescriptionPriceQTYOPTAVIA Select Kits76955 OPTAVIA Select Optimal Kit with the Habits of Health System$ Select Favorites Kit$ #Product DescriptionPriceQTYOPTAVIA Essential KitsIndexing 100%76961 OPTAVIA Essential Optimal Kit with the Habits of Health System$ Essential Optimal Kit$ Essential On-The-Go Kit with the Habits of Health System$ Essential On-The-Go Kit$ #Product DescriptionPriceQTYOPTAVIA Materials50011 OPTAVIA Fuelings Information Cards$ Fuelings Guide (pack of 10)

Prices subject to change. SHIPPING:® All non-expedited orders ship standard ground rates through a common carrier. Receive reduced or free shipping on every BeSlim® Club order over $150 within the continental U.S.* Please note: For non-BeSlim® Club orders, expedited shipping is …

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