Secure Payment Form

This Is Your Current Order
Change Your Order Here
Prod Code Qty Item Description Price TOTAL
CeramicFilterforAdya 1 Ceramic Filter for Adya Filtration Unit   $40.00 $40.00
CharcoalFilterforAdy 1 Charcoal Filter for Adya Filtration Unit   $40.00 $40.00
10002 1 Adya Water Filtration Unit w/ 32oz Adya Clarity   $175.00 $175.00
AcidAlkalineChart 1 Acid Alkaline Chart   $12.00 $12.00
BodySystemsChart 1 BodySystemsChart   $12.00 $12.00
ToothOrganChart 1 Tooth Organ Chart   $12.00 $12.00
TwoCharts 1 TwoCharts   $20.00 $20.00
Subtotal $311.00
Shipping/Handling Charges $31.10
Amount Due $342.10

Enter Your "Remember-Me" Password    Forget Your Password?
(Password Not Required to Order)

Please Complete The Billing/Shipping Information Below

Required fields are marked with *.
Billing Information
First Name:
*
Last Name:
*
E-Mail:
*
Business/Organization Name:
Address1:
*
Address2:
City:
*
State:
Zip Code: *
Phone Number#:
*
Ext:
Fax#:
 
Shipping Information
Check this Box if Same as Billing Information
Please indicate if we will be shipping to a Residence or Business.
First Name:
*
Last Name:
*
Business/Organization Name:
 
Address1:
*
Address2:
City:
*
State:
   Zip Code: *
We Welcome Your Comments:

Check here for Express Delivery. An extra $10.00 charge will apply.

Select Your Payment Method: Credit Card Check



This May Take A Minute - Only Press ONCE

SecurityMetrics PCI Certified