Juice Cleanse Order
We are so excited for you to experience your cleanse! Once we receive your order form with payment information, a PURE rockstar will get in touch with you within 48 hours to arrange pick up day and time.

Please note, we encourage you to do your own research about juice cleanses especially if you have never done one before. If it's your first time, we suggest starting off with a 1 Day Classic Juice Cleanse and working your way up to more if you feel it is right for your body.

Your body is always your best advisor!

Please let us know if you have any questions.
Email *
First and Last Name *
Classic, Advance or Half Day?
Clear selection
Advanced + Classic Cleanses
$65 + tax (+ btl deposit) per day
Half Day Cleanse
$45 + tax (+ btl deposit) per day
How many days? *
Required
ADD-ON:
Clear selection
Your Contact Phone Number *
Billing Address (please include street, unit number, city, province/state, and postal code/zip) *
Credit Card Number (*no American Express) *
Expiration Date *
CVV Security Code (3 digit code on back of card) *
Promo Code:
Authorization
I understand that by submitting this form, I authorize PURE Gym & Juicery (1081310 BC LTd.) to charge my credit card with the above information.
READY? Let's do this!!
Click submit and let's get started!
Submit
Never submit passwords through Google Forms.
This form was created inside of Pure Gym & Juicery. Report Abuse