Yes, please send me the Geneva Health Cookie Diet!  I understand it is fully guaranteed.

I am ordering:     (  ) 1 Box: $29.90       (  ) 2 boxes:  $49.90         (  ) 3 boxes:  $64.90

Please add $4.95 for Shipping and Handling.

Ship to:

Name______________________________________________________________
Address____________________________________________________________
City_______________________________________State_____________________
Telephone_____/____________________

I would like to lose: (  ) less than 20 lbs. (  ) between 20 and 50 lbs. (   )more than 50 lbs.