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P.O. Box 6013  Long Island City, New York 11106

Phone: 1-888-850-9110
Out Side The USA 1-718-850-0811
Fax: 1-718-850-9682/85
imperialgoldmaca@aol.com
www.imperialgoldmaca.com
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Form For Mail-In or Fax Orders

Date: 
Bill To: Ship To: If same as Bill To leave blank
*Name: *Name:
*Address: *Address:
*City: *State:

*Postal Code:

*City: *State: *Postal Code:
*Day Phone: *Day Phone:
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Yes!  I want to take advantage of your reseller program -please contact me. I Am A Regular Customer This Is A Re-Order.

Quan.
Item #
Description
Unit Price
Total

IGM36

Imperial Gold Maca™ Single Bottle 36 Capsules Trial Size 600mg

$10.88

$

IGMC1 Imperial Gold Maca™ Single Bottle 100 Capsules 600mg

$19.89

$

IGMC-3 Imperial Gold Maca™ 3 Bottle Special Total 300 Capsules 6000mg $56.85

$

IGMC-6 Imperial Gold Maca™ 6 Bottle Special Total 600 Capsules 6000mg $99.00

$

IGMC-12 Imperial Gold Maca™ 12 Bottle Special Total 1200 Capsules 6000mg $179.00

$

IGMPB4 Imperial Gold Maca™ Bulk Powder 4.0.oz - 113gr  ¼ Pound Bag  $14.88

$

IGMPB8 Imperial Gold Maca™ Bulk Powder 7.5 .oz - 212gr All Most A Full ½ Pound $21.89

$

IGMPB16 Imperial Gold Maca™ Bulk Powder 16.0 .oz - 454gr A Full  Pound $36.89

$

IGMPB1K Imperial Gold Maca™ Bulk Powder 1 Kilo -  2.2 Pound $59.90

$

IGMPB5K Imperial Gold Maca™ Bulk Powder 5 Kilo -11.25 Pounds $15.91LB $179.00

$

IGMPB10K Imperial Gold Maca™ Bulk Powder 10 Kilo -22.5 Pounds $13.29LB $299.00

$

GIGM-1 Gelatinized Imperial Gold Maca™ Single Bottle 90 Capsules 600mg $29.88

$

GIGM-3 Gelatinized Imperial Gold Maca™ 3 Bottle Special 270 Capsules 600mg $85.89

$

GIGM-6 Gelatinized Imperial Gold Maca™ 6 Bottle Special 480 Capsules 600mg $159.00

$

GIGM-12 Gelatinized Imperial Gold Maca™ 12 Bottle Special 1080 Capsules 600mg $249.00

$

GIGM1P Gelatinized Imperial Gold Maca™ Bulk Powder 16 .oz  - 1 Pound $58.00

$

GIGM1K Gelatinized Imperial Gold Maca™ Bulk Powder 1 Kilo -  2.2 Pound $99.00

$

GIGM5K Gelatinized Imperial Gold Maca™ Bulk Powder 5 Kilo -  11¼ Pounds $289.00

$

LEY695 MACA - Native Food & Medicine of Peru Adaptogen and Hormonal Regulator
Beth M. Ley, PhD. 46 Pages.  This Book answers most questions that men and women may have about this herb food.
$5.89

$

1000 Royal Oil of Oregano - Fights Bacteria Fungus and Parasites with Ease! $34.89

$

RAEI-FX Royal Atomic Energized Iodine 2% Formulation The food for the Thyroid $24.89

$

5086-P SuperFem Multiple Vitamin & Mineral Hormonal Balancer 90 Tablets $16.89

$

5085-P Super Male Maximum with Maca Root and Horny Goat Weed 90 Tab
(3 Bottle Limit)
$19.89

$

 LIST ADDITIONAL ITEMS BELOW NOT LISTED HERE  

$

Subtotal

$

*Shipping & Handling :
  
1-2 Bottles $7.95 - 3-5 Bottles $8.95  - 6-8 Bottles $10.49  7-12 Bottles $12.95  4.0 .oz - 7.50.oz Bag $ 7.49  1 Kilo Bag  $13.49  - 5 Kilo Bag $21.75 10 Kilo Bag $33.50 Shipping Rates Are For USA Delivery Only. For Order's Overseas Send   An E-Mail For Shipping Rates For Your Country.
Orders Are Shipped By US Postal Service Priority Mail

 *Shipping
& Handling
 

$

 REMARKS:

Amount Due

$

Mail Orders may be paid for by Check, Money Order, Cashiers Check, Credit Card.
Make Checks payable to
  A Healthy Alternative, LLC.


Send payment and this order form to address below.

Imperialgoldmaca.com. 
P.O. Box 6013 
Long Island City, New York 11106

Method of Payment:

Check

Money Order

Credit Card 
Visa MCAEDC

Credit Card Number

Exp. Date
Security Code From Rear of Card 3 Digits
AMEX Front 4 Digit

Signature:
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Faxed Orders may be paid for by Credit Card only. Fax Order form with credit card information and signature to the number above. Orders Are Processed Within 24-48 Hours. Mailed Orders with money orders are shipped at once. 
(718)-850-9682 and (718)-850-9685