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Sales-form – Green Science
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Date
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Unit
Product Name
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Green Science
Zen-Alleve
CBD – Tincture
CBD – Capsules
CBD – Gummies
Other(Type In OTHER)
Product Selection
Select
Green Science - 1 bottle
Green Science - 1 bottle-001GS
Green Science - 2 bottles
Green Science - 3 bottles
Green Science - 5 bottles
Green Science - 6 bottles
Green Science - Sample + Subscription
Zen-Alleve - 1 bottle
Zen-Alleve - 1 bottle-001ZA
Zen-Alleve - 2 bottles
Zen-Alleve - 3 bottles
Zen-Alleve - 5 bottles
Zen-Alleve - 6 bottles
Zen-Alleve - Sample + Subscription
CBD-Bonus Tincture – 1 Bottle
CBD-Bonus Tincture – 2 Bottles
CBD–Tincture - 1 bottle-001CBD
CBD–Tincture - 3 bottles @ $49.95ea.
CBD–Tincture - 5 bottles @ $39.80ea.
CBD–Capsules - 1 bottle
CBD–Capsules - 2 bottles
CBD–Gummies - 1 bottle
CBD–Gummies - 2 bottles
Other(Type In OTHER)
Name
Digit are not allowed
Email
Phone
Invalid Phone no.
Payment Method Detail
Dollar Amount
Select
$49.95-
GS(1)
$69.95-
001GS
$89.95-
GS(2)
$139.64-
GS(3)
$183.45-
GS(5)
$247.59-
GS(6)
$14.95P-
S/S
$49.95-
ZA(1)
$69.95-
001ZA
$89.95-
ZA(2)
$139.64-
ZA(3)
$183.45-
ZA(5)
$247.59-
ZA(6)
$14.95P-
S/S
$25.95-
CBDT(1B)
$41.90-
CBDT(2B)
$69.95-
CBDT(1)
$149.85-
CBDT(3)
$199.00-
CBDT(5)
$25.94-
CBDC(1)
$51.88-
CBDC(2)
$25.96-
CBDG(1)
$51.92-
CBDG(2)
Other(Type In OTHER)
Credit Card No.
Please enter valid credit card numbers
Call Center Rep Name
Notes:
Shipping Amount
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Free Shipping
$14.95(Product is Free and S&H is charged)
Other(Type In OTHER)
Credit Card Expired
Invalid Date Format
Call Center Rep Ext
Discount Code(Optional)
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HEALING 15%OFF
GS30 30%OFF
ZA30 30%OFF
Other(Type In OTHER)
Discount Price
Customer's Billing Information
Billing Address 1
Billing Address 2
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United States
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Customer's Shipping Information
Name
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Phone
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Shipping Address 1
Shipping Address 2
Shipping City
Shipping State
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Shipping Zip Code
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Shipping Country
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United States
Upsell Item #1
Reset
Unit
Product Name
Select
Green Science
Zen-Alleve
CBD – Tincture
CBD – Capsules
CBD – Gummies
Other(Type In OTHER)
Product Selection
Select
Green Science - 1 bottle
Green Science - 1 bottle-001GS
Green Science - 2 bottles
Green Science - 3 bottles
Green Science - 5 bottles
Green Science - 6 bottles
Green Science - Sample + Subscription
Zen-Alleve - 1 bottle
Zen-Alleve - 1 bottle-001ZA
Zen-Alleve - 2 bottles
Zen-Alleve - 3 bottles
Zen-Alleve - 5 bottles
Zen-Alleve - 6 bottles
Zen-Alleve - Sample + Subscription
CBD-Bonus Tincture – 1 Bottle
CBD-Bonus Tincture – 2 Bottles
CBD–Tincture - 1 bottle-001CBD
CBD–Tincture - 3 bottles @ $49.95ea.
CBD–Tincture - 5 bottles @ $39.80ea.
CBD–Capsules - 1 bottle
CBD–Capsules - 2 bottles
CBD–Gummies - 1 bottle
CBD–Gummies - 2 bottles
Other(Type In OTHER)
Dollar Amount
Select
$49.95-
GS(1)
$69.95-
001GS
$89.95-
GS(2)
$139.64-
GS(3)
$183.45-
GS(5)
$247.59-
GS(6)
$14.95P-
S/S
$49.95-
ZA(1)
$69.95-
001ZA
$89.95-
ZA(2)
$139.64-
ZA(3)
$183.45-
ZA(5)
$247.59-
ZA(6)
$14.95P-
S/S
$25.95-
CBDT(1B)
$41.90-
CBDT(2B)
$69.95-
CBDT(1)
$149.85-
CBDT(3)
$199.00-
CBDT(5)
$25.94-
CBDC(1)
$51.88-
CBDC(2)
$25.96-
CBDG(1)
$51.92-
CBDG(2)
Other(Type In OTHER)
Discount Code(Optional)
Reset
Select
HEALING 15%OFF
GS30 30%OFF
ZA30 30%OFF
Other(Type In OTHER)
Upsell #1 Discount
Upsell Item #2
Reset
Unit
Product Name
Select
Green Science
Zen-Alleve
CBD – Tincture
CBD – Capsules
CBD – Gummies
Other(Type In OTHER)
Product Selection
Select
Green Science - 1 bottle
Green Science - 1 bottle-001GS
Green Science - 2 bottles
Green Science - 3 bottles
Green Science - 5 bottles
Green Science - 6 bottles
Green Science - Sample + Subscription
Zen-Alleve - 1 bottle
Zen-Alleve - 1 bottle-001ZA
Zen-Alleve - 2 bottles
Zen-Alleve - 3 bottles
Zen-Alleve - 5 bottles
Zen-Alleve - 6 bottles
Zen-Alleve - Sample + Subscription
CBD-Bonus Tincture – 1 Bottle
CBD-Bonus Tincture – 2 Bottles
CBD–Tincture - 1 bottle-001CBD
CBD–Tincture - 3 bottles @ $49.95ea.
CBD–Tincture - 5 bottles @ $39.80ea.
CBD–Capsules - 1 bottle
CBD–Capsules - 2 bottles
CBD–Gummies - 1 bottle
CBD–Gummies - 2 bottles
Other(Type In OTHER)
Dollar Amount
Select
$49.95-
GS(1)
$69.95-
001GS
$89.95-
GS(2)
$139.64-
GS(3)
$183.45-
GS(5)
$247.59-
GS(6)
$14.95P-
S/S
$49.95-
ZA(1)
$69.95-
001ZA
$89.95-
ZA(2)
$139.64-
ZA(3)
$183.45-
ZA(5)
$247.59-
ZA(6)
$14.95P-
S/S
$25.95-
CBDT(1B)
$41.90-
CBDT(2B)
$69.95-
CBDT(1)
$149.85-
CBDT(3)
$199.00-
CBDT(5)
$25.94-
CBDC(1)
$51.88-
CBDC(2)
$25.96-
CBDG(1)
$51.92-
CBDG(2)
Other(Type In OTHER)
Discount Code(Optional)
Reset
Select
HEALING 15%OFF
GS30 30%OFF
ZA30 30%OFF
Other(Type In OTHER)
Upsell #2 Discount
Total Amount
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