Retail Order Form

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Retail Order Form

Your First Name:

Your Last Name:

Sponsor's Full Name:

Sponsor's User Name:

Shipping Street Address:

City:

State:

Zip:

Phone:

Email Address:

Billing Street Address: (if different from shipping address)

City:

State:

Zip:

Choose how many cases of RhodiGandha the liquid beverage you want for your initial purchase:
The 4 bottle cases are $149.95 each plus shipping of $16.95 each
One $166.90 Two $333.80

The 12 bottle Family Packs are $419.95 each plus shipping of $50.85 each
One $470.80 Two $941.60

WHOLESALE PRICING FOR PREFERRED CUSTOMER CLICK HERE

Pay by personal check:

Bank Name:

Routing Number:

Account Number:

(Optional) Please add any comments you have below: