HOWARD RUFF’S

Hi Q BRAIN FOOD

ORDER FORM

NAME ________________________________________________________________

ADDRESS _____________________________________________________________

CITY/STATE/ZIP _______________________________________________________

PHONE: _______________________________________________________________

EMAIL: ________________________________________________________________

DATE _____________________________      ___ OLDER or ___ YOUNGER than 50?

___ 1 BOTTLE    = $59.95                                                                   $  59.95                       

BEST OFFER:                                                                                                                           

___ 2 BOTTLES = $49.95 each                                                                                               $ 99.90 

Shipping $    4.95            $   4.95

TOTAL                                                                                                $  64.90                        $104.85

***Utah Residents please add 6.25% for state sales tax.

PAYMENT METHOD:

___ Check or money order for $___________ payable to Hi Q Nutrition.

___ Bill Me Program. For a shipping fee of $6.95, please include a bill. I will return payment within ten days.

Please charge my ___ visa or ___ mastercard

Card # ______________________________________________  Exp: ______________

Signature _______________________________________________________________

___ Please add me to your quarterly AutoShip Program and send me three bottles each quarter. I will receive an even bigger discount on my quarterly AutoShip orders ($34.95 per bottle – up to $15 per bottle).

*** Our one-condition, money-back guarantee! ***

You must first use up your two-month's supply. Because food

supplements aren't like fast-acting drugs, it takes time to overcome

what may be years of inadequate nutrition. If, after two months, on

your original order, of faithfully taking Hi-Q, you are not happy for

any reason, just return the two empty bottles within three months of

original order for a prompt and full refund. Please call us to pre-approve

this. Because we have gone to the trouble and expense to prepare

and ship the package, you will be charged a $50 on any return that has

not been pre-approved. Guarantee does not apply to single bottle purchases.

FOR FASTER SERVICE CALL TOLL-FREE 877-665-6818 (801-491-4075 outside U.S.)

OR

FAX THIS PAGE TO 801-224-3662

OR

MAIL ORDER TO:

Hi Q ENTERPRISES

P. O. Box 441

Orem, UT 84059