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To order the Trim Program of your choice

just complete this application form and

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If you wish to pay by check or money order, or just prefer to mail or fax your order, rather than  order on-line, click below for a printable version of the order form. 

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Please send me the Trim At Home Program indicated below (Presently available in the U.S. only):

TRIM SHAPE UP PROGRAM - $40.00
Complete 4 week self guided Program, includes 4 Menu Plans, Study Guide, set of Recipes & all related material. Recommended for individuals only needing to lose about 10 pounds.

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TRIM SLIM DOWN PROGRAM - $60.00
Complete 6 week self guided Program, includes 6 Menu Plans, Food Use & Shopping Guide, Do's & Don'ts Student Orientation, Trim Option List, Set of Recipes, Personal Weight Chart, 6 Food For Thoughts, and Study Guide. 

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TRIM PERSONAL GUIDANCE PROGRAM - $75.00
Complete 8 week Program, includes 8 Menu Plans, 2 Study Guides, set of Recipes, all related material & features weekly monitoring by a Trim Program staff specialist.

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In order to process your request you must select a program from above.

* Required Information

Payment Information

Credit Card *

Cardholder Name *
Card Number *
Expiration Date *
CVV / CVC* The CVV/CVC number refers to the 3 digit number located on the back of your card that serves as the card's security code.
Billing Address Zip Code*

MAILING INFORMATION
Full Name *
Street Address *
Address (cont.) 
City *
State *
Zip Code *
E-Mail Address *

 

TO RECEIVE THE CORRECT MENU SERIES, PLEASE PROVIDE THE INFORMATION REQUESTED.

THIS APPLICATION AND ALL QUESTIONS MUST BE COMPLETED ACCURATELY AND IN FULL BEFORE ANY MATERIAL CAN BE SENT.

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CURRENT WEIGHT:*   DESIRED WEIGHT:*

HEIGHT: * Feet   * Inches    

AGE: * (you must be 18 or older to order)

SEX: *

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*1- Please list all medical problems. Do you have high cholesterol? If yes, please indicate total cholesterol, LDL, and HDL levels.
*2- What medications, if any do you routinely take?
*3- Are you lactose intolerant or allergic to any foods? Do any foods cause digestive problems?
*4- Will the alcohol restriction on the Trim Program be a problem?
*5- What and how often is any kind of physical activity done?
*6- What other weight loss methods have you tried? Were they successful?
*7- How did you hear about The Trim Weight Control Program?
*8- Where do you feel your weaknesses lie in regard to dieting?
*9- Do you feel you have good eating habits? Do you turn to food in times of stress?
*10- Give a brief history of your weight problem. Are other family members overweight?
*11- Are those close to you supportive of your desire to lose weight?
*12- What made you decide to lose weight?

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