No information will be sold, traded, or given out for any reason - EVER!
You must provide a valid email to receive
your samples and information.
address receive no samples!
Also: "You must be at least 18 years of age to
receive anything offered at this site"
What is your current weight?
What is your desired weight? (in lbs)
Are you sensitive to taking pills? Yes
About how many 8oz. Glasses of water per day do you
Are you Diabetic? Yes
Do you have Hypertension or Severe Hypertension?Yes
Are you on any special type of medication? Yes
Please list them:
How did you hear about Be Naturally Fit?
If Search Engine - Which One?
What Search Term or Phrase did you use to find us?
PLEASE NOTE: All the above fields must be
complete before free sample package will be mailed.
Additional comments or special instructions
Information on how to take the
Rite-Now Classic Weight Loss will come with
your free samples.
Should you have questions, please call:
Cutie Jackson at 1-706-231-8424 or email: email@example.com . Thanks Kindly.