PAYMENT OPTIONS:
To order a single diet plan from this form, send a check, Purchase Order, Certified Check, or Money Order in the amount of $35.00 to:

Webdietitian
P.O. Box 6037
Terre Haute, IN 47802

Or, you can fax your order form to: 812-299-2999

To order the Diet Planning Guide CD, please enclose $235.00.

Note: For personal checks, order will be processed after checks are cleared.

Cost of DPG covers sales tax and shipping & handling within the U.S. Shipping within the U.S. will be via U.S. Priority Mail.

For International delivery, add $15.00 to the total cost.

Please allow 2 - 4 weeks for delivery.

ORDER YOUR DIET PLANNING GUIDE:
*     Kilocalorie (Custom only)  
 
PERSONAL INFORMATION:
This will help in ensuring the best possible diet plan you've selected.
Gender:
Male   Female
Weight: lbs.
Height: ft. in.
Age:
Activity: Very Light (sitting, standing, typing, sewing, etc.)
Light (walking, garage work, housecleaning, golf, etc.)
Moderate (cycling, yardwork, tennis, dancing, etc.)
Heavy (basketball, climbing, running, soccer, etc.)
Exceptional (training in professional or world-class athletics)
 
* Name:
* Address:
* City:
* State:
* Zip:
* Telephone:
* E-mail:
 
  ( * ) Denotes required field.
 
SHIPPING INFORMATION:
This is the address to which your receipt will be sent, and your product will be shipped unless otherwise specified.
 
Ship to address above
Ship to address below
 
Name:
Address:
City:
State:
Zip: