Canada Mail Order Form
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Ship To Information:

Name:

Address 1:
Address 2:

City:

State:

Zip Code:

Telephone:

Email address:
How did you hear about us?

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Radio Word of mouth Email
Other: ___________________________
Order Information


I would like to order:

(price includes $8.95 CAD shipping)

1 bottle of Vilantae Capsules.....$48.90 CAD

2 bottles of Vilantae Capsules.....$88.85 CAD

3 bottles of Vilantae Capsules.....$128.80 CAD


1 bottle of Vilantae Powder.....$48.90 CAD

2 bottles of Vilantae Powder.....$88.85 CAD

3 bottles of Vilantae Powder.....$128.80 CAD

Other: Please specify and add total below:






(please write in and calculate total if ordering more than 3 bottles, or if you would like to order a different product.)
Shipping is a flat $8.95 CAD regardless of order size.
We will send you an email confirmation as soon as your order ships.

Please print this page and mail with
check or money order to:

Evolution-X Inc.
454 W. Coleman Blvd
Suite 2D
Mount Pleasant, SC 29464


Checks should be written out to Evolution-X. Delivery generally takes 3-4 days from the time we receive your order form.