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    Order Type* :

    Name* :

    Number* :

    Email* :

    Address* :

    Notes

    Payment: Payment due on invoice.

    Cancellation Policy: All orders are fixed. Store credit is offered.

    Delivery: Only available in Vancouver.

    Bottle Deposit is included.



    Cleanse
    # of Days


    Revive Basic ($65/day)
    Revive w/ Nut Mylk ($75/day)
    Revitalize Active ($80/day)
    Revitalize w/ Nut Mylk ($88/day)
    21 Day Cleanse ($1240)
    21 Day Cleanse w/ Nut Mylk ($1340)

    Full amount provided on invoice.


    Pickup/Delivery Date:

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