WELLNESS CAPSULE FORM

wellness capsule

First Name

Last Name

Address

Address Line 1

Phone/Mobile

Multiselect

Buy one bottle for 590ghc(Two weeks Dosage)Buy Two Bottles for 790ghc(1 Month Dosage)Buy Three Bottles for 1140ghc( 2 months complete Dosage)Buy Four Bottles for 1490ghc(3 Months treatment)Buy Five Bottles for 1840ghc(3 months and two weeks treatment)Buy Ten Bottles for 3690ghc(4 Month Total Treatment)

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