Mail Order Form

Advance Order Mail Order Form

If you'd like to order by mail and have your report delivered to you via email, give us your email address below and we'll send it out to you as soon as we receive your order.

Sorry, because we've receive so many bad checks in the past, we can no longer accept them. Cash and money orders ONLY. Thank you.

No Checks! - Money Orders or Cash Only - No Checks!

"Avoiding Alzheimer's" - Only $20.00

Email Address ___________________________________________________________________

- PLEASE print clearly in block letters -

Ariza Health Research Press, 8803 Brecksville Rd, #7-222, Brecksville, OH 44141

Thank you for your purchase!

If you can't print out this form - just write out your order
on a piece of paper but please print very carefully!