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HEALTHY CHOICES LEAD TO A HEALTHY LIFESTYLE
The ways of right-living people glow with light; the
longer they live, the brighter they shine.
- Proverbs 4:18
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Standard Process Purification Order Form
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First & Last Name
Phone Number
Email
an email you check
email
Address
City, State, Zip
Gender
pick one!
Male
Female
Vegetarian?
pick one!
Yes
No
Gluten Free?
pick one!
Yes
No
Dairy Free?
pick one!
Yes
No
If you are Dairy free, there are two options for you below noted as Dairy Free.
Which Purification Program do you want?
Purification Programs
pick one!
Select A Purification Program
12010 Purification Product Kit with SP Complete® and Gastro-Fiber® $243.50 minus any specials that may be running.
12020 Purification Product Kit with SP Complete® and Whole Food Fiber $262.50 minus any specials that may be running.
12065 Purification Product Kit with SP Complete® Chocolate and Gastro-Fiber® $243.50 minus any specials that may be running.
12070 Purification Product Kit with SP Complete® Chocolate and Whole Food Fiber $262.50 minus any specials that may be running.
12035 Purification Product Kit with SP Complete® Dairy Free and Gastro-Fiber® $243.50 minus any specials that may be running.
12040 Purification Product Kit with SP Complete® Dairy Free and Whole Food Fiber $262.50 minus any specials that may be running.
12055 Purification Product Kit with SP Complete® Vanilla and Gastro-Fiber® $243.50 minus any specials that may be running.
12060 Purification Product Kit with SP Complete® Vanilla and Whole Food Fiber $262.50 minus any specials that may be running.
Do you crave sugars and/or carbohydrates like breads, pastas or sweets often during the day? If so, you may want to order an herb called Gymnema during the cleanse to assist you with cravings. Would you like that included for the cost of $22.00?
Gymnema
pick one!
Yes
No
You will need to be taking a quality fish oil for the cleanse, do you need one provided for you? If yes, would you like that included in your order for the cost of $25 minus any specials that may be running?
Fish Oil
pick one!
Yes
No
Will you be picking this order up at our office or are we drop-shipping this to you at the address you provided above? If yes, include a $13 drop-ship fee.
Pick up or Dropship?
pick one!
Select An Option
Pick Up
Dropship
What is your expected start date for your 21 Day Purification Program? This date will be used to start your Purification Email Support Program. The date can be changed if you start on a different date.
Date to start the program
date_range
Important: Sales tax will apply in states outside of Texas as applicable.
Submit Form
Shortly after you submit this form you will receive an invoice for the total amount of your order from Access Complete Wellness from this email address: invoicing@messaging.squareup.com. Once the invoice has been paid your order will be processed.
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