Fast Weight Loss

Your investment for everything, the complete body transformation course jam packed with success secrets, tips, strategies, sample diets and exercise programs tailored to your situation and goals, and everything mentioned on the About The Program  page is only $97.00 for the hard copy version...or $49.95 for electronic version! Either version of the program will contain the exact same information.

Weight Loss Program OPTION #1 Electronic Version Sent Directly To Your Email Address $49.95 Delivery Time: 3-7 business days (To order now, please complete the form below)

Weight Loss Program OPTION #2 Hard Copy Version Sent Directly To You Via U.S. Mail $97.00 Delivery Time: 2-4 weeks (To order now, please complete the form below)

(Either version will contain the exact same information). You can choose the option you want in the Personal Information Form (below).

IMPORTANT: You need to complete the form below to supply us with the information we need so that we can send you the appropriate weight loss program that is tailored to your situation and your goals.

Please fill out the following information and click submit at the bottom of the form. After you submit this form, you will be taken directly to our secure online payment site. First, Choose A Version Of The Weight Loss Program * required $ 49.95 - Electronic Version Sent Directly To The Email Address You Indicate On This Form (You will receive the electronic version within 3-7 business days ) $ 97.00 - Hard Copy Version Mailed Directly To You Via U.S. Mail (You will receive the hard copy version within 2-4 weeks) Your First Name Your Last Name Gender:     Male        Female Height Age Street Address City State or Province Zip or Postal Code Just In Case We Have Any Questions While Customizing Your Program, Please Let Us Know How We Can Contact You : Phone Best time to call Your eMail address    *required Please Check The Category That Best Describes Your Body Transformation Goals: Weight Loss Only Weight Loss & Toning Increase Muscularity & Weight Loss Weight Gain Only Weight Gain And Toning Increase Muscularity & Weight Gain Other    (please describe) If You Are Interested In Toning or Increasing Muscularity, please let us know what type of weight training experience you currently have: None Beginner Intermediate Advanced How Much Do You Weigh Now? What Is Your Goal Weight? Please list your problem areas: (example: thighs, rear-end, stomach, arms, my entire body, etc...) Exercise Information: How many days a week can you dedicate to exercise? How many hours a day can you dedicate to exercise? If any, please list what days you want off from exercising. Are you going to exercise at home or in a health club/gym. If you are exercising at home, please list equipment you have (if any): Do you have a VCR? Can you walk for 30 minutes without stopping? If yes, at what pace? example; slow, medium, fast, jog, run If no, how many minutes could you walk for at a slow pace? How many times do you normally eat a day? Please list any health problems or physical disabilities: Dietary Information: Are you a vegetarian? No Yes If you are a vegetarian, please list sources of protein you enjoy eating: (Example: types of cheese, beans, breads, cereals, nuts, peanut butter, tofu, etc...) Please put a check next to the foods you DO NOT LIKE: Chicken Turkey Steak Fish Canned Tuna Pasta With Tomato Sauce Rice Baked Potato Garden Salad Please list the fruits you will eat: Please list the vegetables you will eat: Please list the beverages you presently drink: Will you drink water? Will you drink or eat a meal replacement shake or bar and take supplements that will help you achieve your goals? (By no means is this mandatory to participate in our program): Yes No Comments Please include any other information you feel we need to custom tailor your weight loss program, expedite your order and process it accurately: Upon Form Submission, You Will Be Taken Directly To Our Secure Payment Site. If you have a problem submitting this form, please call 1-732-842-0935 between 9am - 5pm Eastern Time Thank You For Your Order.