Products Price Quantity Total

Products		Price	Quantity	Total
Blood Chemistry Analysis + Results Review	$450.00 $297.00	Update	$297.00
Subtotal			$297.00

Blood Chemistry Analysis + Results Review

$450.00

$297.00

Update

$297.00

Subtotal $297.00

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Order Summary
Subtotal	$297.00
Order total	$297.00
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I authorize Dr. Ritamarie LLC to charge me for the order total listed above and agree to remit a payment to Dr Ritamarie LLC. I further affirm that the name and personal information provided on this form are true and correct. I further declare that I have read, understand and accept Dr. Ritamarie LLC's business terms as follows.

The products and services to be purchased in this transaction are owned solely by Dr Ritamarie, LLC and can only be used by the purchaser for his/her own use and education. These products and services cannot be used for any other purpose, including, but not limited to: resale, posting on web or social media sites, licensing or any commercial transaction without the written consent of Dr Ritamarie, LLC.

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