Order form

The ProDietÔ Plan order form


Name:
Street Address:
City:
State, Zip:
Telephone:

*Age:	MALE FEMALE
*e-mail address:
	I understand that payment will be required prior to processing order.
*Please list other diets you have tried
Waiver
Please be sure to check with your physician prior to beginning this diet. The ProDiet is not FDA approved and all material provided on the ProDiet Web site is provided for informational or educational purposes only. Weight loss varies from person to person and all claims made represent the average weight loss on this program. Acknowledging that the ProDiet represents a dramatic change in an individual's metabolism, I agree that the ProDiet Plan, their agents, servants and employees shall not be liable to me for any injury or damage resulting from my participation in the ProDiet Plan, whether or not the the ProDiet Plan is followed as instructed. I will not sue, arrest or attach or prosecute any of said persons and entities and I hereby release, discharge and agree to hold harmless said persons and entities from all actions, claims and demands I may have for injury or damage.

Signature Payment in full must be received before the ProDiet will be mailed
The ProDietÔ Plan - for a healthier lifestyle