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FREE
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Your Full Name*
SIN#/SSN# (only for distributorship)
Co-Applicant
Business Name
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City*
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E-Mail Address*
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Business/Fax Number

Please Note: Items with an * must be entered for this application to be processed.  Any applications sent without those areas entered will be placed on hold.


Your choice of the following Information Packages will be sent as our FREE gift to you when you place your order. More Info-Packs to be released in upcoming months...

Cancer In Your Home? -- Uncovering the Harmful Ingredients in Shampoos, toothpaste, etc. Learn what works, what doesn't, and why!
Hotflash! Learn all about Progesterone and Endau's super-charged formula with Betty Kamen Ph.D.
"Death By Default" What your Doctor Can't or Won't Tell You. Go Beyond Colloidal Minerals with E.Jackson Stockwell
Nature's Miracle Rediscovered! - Pycnogenol, Grape Seed Extract, Pine Bark Extract, and other antioxidants. By Dr. Bob Martin
Parasites...The Unwelcomed Guests -- An Investigative Report on the Parasite Epidemic with Dr. Toby Watkinson (from the "Let's Talk About Your Health" Series)
The "No Die" Diet -- 21st Century Weight Management and Supportive Materials ***Special Website Section now under Construction***
The Wealth You Deserve: Your opportunity as a distributor with our team

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Select your "Health & Vitality" Interests:

Antioxidants
Colloidal Nutrition
Car Care
Dental Care
DHEA, Melatonin, etc.
Eye Health
Hair Care
Harmful Ingredients
Herbs for Health
Memory and Mental
Non-toxic Home Care
Parasite Cleansing
Progesterone Cream
Skin Care
Tanning Solutions
Weight Loss

Please Enter any Comments, Questions, or Suggestions Here:


If you require any assistance in submitting this FREE application form, just click on HealthWAVES Helpdesk and ask for assistance.

If You would rather Fax the information, please read below:
To fax this form, please fill in the information on this form, and then press the <PRINT> button on your browser, then Fax it to (604) 431-0575. You will then be input into the corporate computer and qualified to recieve the wholesale discount of 30% off!

NOTE: When you decide to have your products shipped automatically each month, you will receive our exclusive "Business In A Box InfoCentre", a $35 value, absolutely FREE as our gift to you.

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Email: [email protected]
Website: www.compuheaven.com
Call Us: (604) 431-0575

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