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BioZest order form
BioZest concentrate. 1 Litre concentrate makes 5-8 Litres of Sports Energy Drink.
Please choose from 0-4 for each of the flavours.
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Email
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Your email
Your details
Your name & surname
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Your answer
Cell phone number
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Your answer
Club
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Choose
Vineyard
AquaWolf
Cybersmart
Westridge
Camps Bay
Barracudas
Khayelitsha
X-stream
UWC Aquatics
Hurricane
Blue Downs
Modderdam
Players
Paarl Aquarius
Worcester Aquatics
Swartland
Curro Langebaan
Knysna Dragons
Royal Swim Academy
Curro Hermanus
Other
Delivery point
*
Sweet Valley Primary School pool
Planet Fitness Plattekloof pool
Other:
Order detail
Please choose from 0-4 for each of the flavours.
Forest Berry (1 Litre concentrate)
*
Choose
0
1
2
3
4
Orange (1 Litre concentrate)
*
Choose
0
1
2
3
4
Naartjie (1 Litre concentrate)
*
Choose
0
1
2
3
4
Lemon & Lime (1 Litre concentrate)
*
Choose
0
1
2
3
4
Tropical Fruit (1 Litre concentrate)
*
Choose
0
1
2
3
4
Order total
Please total your order. Add all the numbers above.
Total order (Number of 1 Litre concentrates)
*
Choose
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Pricing: R58 per 1 Litre Concentrate
Total price
*
Choose
1 = R58
2 = R116
3 = R174
4 = R232
5 = R290
6 = R348
7 = R406
8= R464
9 = R522
10 = R580
Banking details
Payment option. Proof to
gary@vineyardswimming.co.za
*
EFT: Capitec Bank: ACCOUNT BioZest Vineyard NUMBER 162 394 3866
Cash
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