Order Number | *Nominate a FOUR digit order number - Example: 5252

Name of Cali Employee Placing Order | *Note: Employee must state their name

Store Pick-up Location or Home Delivery

Customer Delivery Address | *If required

Customer Name

Customer Email

Customer Phone

Cleanse Type

Total Cleanse Duration

Amount of Days Remaining For Delivery

Remainder of Cleanse Delivery Date | Note: Delivery days are MON, THU

Have you emailed an e-book to the customer? | *Not required during busy times in the shops

Has the customer paid in full? | *Note: Do not process an order without taking payment

Additional Instructions