Order Form

Get Your Miracle Relief FormulaŽ At The Special
Low Price Of Only $29.95 A Jar, Or Less!    

   YES!  Rush me one 4 oz. Jar of Miracle Relief FormulaŽ @ $29.95 plus $4.00 shipping & handling.                  

 YES!  I am Ordering 3 Jars of Miracle Relief FormulaŽ for a total of  $99.85. ($89.95 plus $10.00 shipping),  
AND I GET A 4th JAR FREE!  A savings of $29.95.                                                                                               


Mail Orders to: Hoelscher Marketing Group, 1145 N. Second Street, El Cajon, CA 92021.   
E-Mail: rvhmedia@aol.com  Ph. 1-619-588-2155.  Fax: 1-619-588-9103. 

  Enclosed is: ($ Total). 
I am paying by:  []Check  [] Money-Order 

Ship To: Name:
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Credit Card # Exp. Date

I'm paying by: ( ) Check ( ) Money Order ( ) VISA ( ) MasterCard ( ) American Express

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