WAVESHAPER Frequency Instrument - SPECIAL ORDER FORM
NOTE: Please set ALL Margins at 0.50", Print Out, Fill Out, SIGN and Send To:
TOTAL HEALTH ASSOCIATES
774-D S. Chesterfield Rd.
Columbus, OH 43209-2683
Sales & Info/614-237-2590

Please accept my Order for __ WAVESHAPER Frequency Instrument(s). I understand that, if I am NOT satisfied with my purchase, the WAVESHAPER Frequency Instrument has a 30 day MONEY-BACK Guarantee. I also understand that, if I'm returning the WAVESHAPER Frequency Instrument, it must be returned in a SALEABLE Condition and that there will be a 15% Restocking Fee.
NOTE: ANY Unit, which has been DAMAGED, TAMPERED with &/or which has had it's Case OPENED, is NOT RETURNABLE.

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 and also use this Form, if ACCESSORIES &/or additional Healing Tools are being ordered).
NOTE: Please send a U.S.P.S. Money Order for NEXT Day Shipping from the Factory. Company or Personal Checks take about 3 days to CLEAR. CASH will ONLY be accepted in Person. Please ADD $15 for 1 - Unit & $25 for 2 - Units above, if you NEED to have 2nd Day Air FedEx Delivery. The WAVESHAPER Frequency Instrument will be shipped by U.P.S., so that you must provide a Street Address 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 WAVESHAPER Frequency Instrument for one or MORE of the following uses ONLY: Experimentation, Testing, Educational, Technical, Esthetics, Veterinary Work, Relaxation, Meridian Balancing &/or Energy Charging.

 _________________________________________________________________________________
Signature + Name (print clearly)                                                                      Date

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

_________________________________________________________________________________
Phone No.                                                                                                    Email Address