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BioTec2000 UNITS - SPECIAL ORDER FORM
NOTE: Please set ALL Margins at 0.50", Print Out, Fill Out, SIGN and Send To:
TOTAL HEALTH ASSOCIATES    or
P.O. Box 9872
Columbus, OH 43209-0872
TOTAL HEALTH ASSOCIATES
774-D S. Chesterfield Rd.
Columbus, OH 43209-2683

Please accept my Order for __ BioTec2000 Frequency Instrument(s) &/or __ BioTec2000 Ray Tubes Unit(s). I understand, if I decide to return either or both units for a REFUND, that they must be returned in the SAME Condition in which it/they was/were received and that a 25% Restocking Fee will be DEDUCTED from your REFUND.
NOTE: ANY Unit, which has been DAMAGED, TAMPERED with &/or which has had it's Case OPENED, can NOT be returned.

I'm enclosing: $__________ (DISCOUNT Price) + $__________ (2nd Day Air U.P.S., if applicable - see below) = $__________ (TOTAL Amount - please insert in the AMOUNT window on the ORDER FORM.
NOTE: If you send a U.S.P.S. Money Order, your Order will be dropshipped from the Factory in CA on the day, after it is received. And if you send a Cashier's, Personal or Company Check, my Bank usually takes 3-5 days to CLEAR it. CASH should NOT be sent. Please ADD $25 for 1 - Unit & $40 for 2 - Units above, if you want 2nd Day Air FedEx Delivery. The BioTec2000 Unit(s) are normally shipped by U.P.S., and so you must provide a Street Address (see below).

I hereby AGREE to the above and the following Terms and Conditions:
I, the undersigned, hereby declare that I am NOT ordering on behalf of a Government Agency for the purpose of ENTRAPMENT or otherwise. I am purchasing the BioTec2000 Frequency Instrument &/or BioTec2000 Ray Tubes Unit for one or MORE of the following uses ONLY: Experimentation, Testing, Educational, Technical, Esthetics, Veterinary Work, Relaxation, Meridian Balancing &/or Energy Charging.

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Signature + Name (print clearly)                                                                      Date

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Shipping Address: Number, Street, City, State & ZIP or Postal Code & Country (if applicable)

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Phone No.                                                                                                    Email Address