Your Phone Number (required) Card Number (required) Card Expiry (required) CVV number (required) Amount To Charge** (required) I hereby authorise the Institute For Functional Health to charge the above credit/debit card for the amount specified *Please note that final charged amount may differ marginally due to fluctuations in foreign exchange currency rates ** Please use the table below to calculate the amount to charge (eg. a single order of 5 units is NZD$150 x 5 units + NZD$45 delivery charge = NZD$195). Any inconsistencies may result in delays. Price per V9 NZ$150Courier charge per despatchNZ$45Max units per orderx10Price Sheet