CSN Online Order Form
CHRISTO STRYDOM NUTRITION INTRODUCED BY: BAINS LODGES INTERNATIONAL (PTY) LTD
This form is for ordering purposes only. For general inquiries/quotes please visit the link below.
Are you a
New CSN customer
Returning Client save time and send me an email with your order to
Name and Surname
Physical Address (No deliveries to farm/plot addresses)
Your nearest Postnet from which you will be able to collect:
Marital status and Occupation
I will collect my own order from:
PRETORIA OFFICE- MORELETA PARK
HIGH BLOOD PRESSURE
Prescribed medication for the health condition mentioned above
Any know allergies
Current Weight, Goal Weight and Height
Have you undergone any surgery that we should know of and when?
ANY OTHER INFORMATION WHICH MAY BE RELEVANT TO THE SUCCESSFUL PARTICIPATION IN THE CSN PROGRAM?
BE KIND AND HELP US OUT: What do you google when searching for a weight loss solution?
Where did you hear about us?
I DECLARE THAT ALL OF THE ABOVE MENTIONED INFORMATION IS CORRECT
INDEMNITY I acknowledge that I have been warned that participation in the Christo Strydom Nutrition Program (CSN Program) might present potential serious health hazards. I declare that I voluntarily elected to participate in the above mentioned program despite the potential risks involved and that such participation is undertaken entirely at my own risk. I accept that none of Christo Strydom in his personal capacity, or in his capacity as the authorized representative of any of the entities involved in this program or their employees, or representatives, shall become legally liable for any damages resulting from my participation in the Christo Strydom Nutrition Program. I further accept that this indemnity will also be applicable in the event of participation in activities arranged and/or provided by any of the entities mentioned in the above mentioned agreement and/or Christo Strydom in his personal capacity. I further acknowledge that this agreement will also apply to any third party employed by Christo Strydom in his personal capacity or in his capacity as the authorized representative of any entity mentioned in this agreement, medical staff and practitioners included. I hereby discharge Christo Strydom in his personal capacity and the above mentioned entities, medical staff and practitioners from all claims, personal or otherwise, emanating from loss or damages suffered by me during my participation in the Christo Strydom Nutrition Program.
PART 2: Please take note
THE 60 DAY MEAL PLAN IS INCLUDED IN ANY OF THE PACKAGES PURCHASED (SEE INSIDE NATURAL HEALTH SUPPLEMENT TUB)
PLEASE SEND POP TO
FOR ORDER TO BE PROCESSED
DELIVERY TAKES UP TO 3 DAYS AFTER PAYMENT HAS BEEN MADE
EMAIL US FOR YOUR PARCEL'S TRACKING NUMBER
PLEASE LOWER ALOEMAG DOSAGE TO 2 x pd AFTER DIARRHEA SETS IN
YOU CAN HAVE UP TO 4 CUPS OF COFFEE AND TEA WITH FAT FREE MILK AND STEVIA/SUGANON SWEETNER
TABLETS & CAPSULES ARE THE EXACT SAME PRODUCT IN A DIFFERENT FORM
IF YOU WOULD LIKE TO JOIN OUR SUPPORT GROUP SEND US A WA TO 0606677681
GO LIKE OUR FB PAGE: CSN - KARIEN NEL FOR RECIPES, MOTIVATION AND SPECIALS
SELECT THE CSN PACKAGE BEST SUITED FOR YOU. (For more info regarding the packages email:
Detox Pack for R999 (1 x Health Supplement Tablets, 1 x Barley Grass, 1 x AloeMag)
Diabetic Detox Pack for R999 (1 x Health Supplement Tablets, 1 x Barley Grass, 1 x AloeMag)
Detox Pack for R1068 (1 x Health Supplement Capsules, 1 x Barley Grass, 1 x AloeMag)
Diabetic Detox for R1068 (1 x Health Supplement Capsules, 1 x Barley Grass, 1 x AloeMag)
Detox & Month Pack for R2377 (3 x Health Supplement Tablets, 1 x Barley Grass, 1 x AloeMag)
Diabetic Detox & Month Pack R2377 (3 x Health Supplement Tablets, 1 x Barley Grass, 1 x AloeMag)
Detox & Month Pack for R2548 (3 x Health Supplement Capsules, 1 x Barley Grass, 1 x AloeMag)
Diabetic Detox & Month Pack for R2548 (3 x Health Supplement Capsules, 1 x Barley Grass, 1 x AloeMag)
FOR INDIVIDUAL CSN PRODUCT ORDERS eg: 1 x AloeMag. 2 x Barley Grass Capsules etc.
Thank you for you support and we wish you all the best on your CSN WEIGHT LOSS JOURNEY. Please visit my website
for CSN-Recipes and join our Facebook Page: CSN Diet Support Group for interactive support and motivation. For any other inquiries send us an email to
Send me a copy of my responses.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service