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Custom Form - Fillable2

Custom Form - Fillable2

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Published by BioElectricShield
Anyone with special health challenges or energy senstitivies can benefit from an individually customized shield. This document describes the product and how to submit an free inquiry to see if this type of shield would make a significant, positive change in your life.

If you have specific health concerns or if you simply want to know which Shield is best for your energy field, fill out and return this form with a photo for a free consultation.
(Because of confidentiality issues, you won't get an in-depth aura reading or any specific information other than what Shield is best for you, or if you need a custom. None of this information is disclosed to us. If you desire more in-depth information please contact us for information on how you can make an appointment with our consultant)
Anyone with special health challenges or energy senstitivies can benefit from an individually customized shield. This document describes the product and how to submit an free inquiry to see if this type of shield would make a significant, positive change in your life.

If you have specific health concerns or if you simply want to know which Shield is best for your energy field, fill out and return this form with a photo for a free consultation.
(Because of confidentiality issues, you won't get an in-depth aura reading or any specific information other than what Shield is best for you, or if you need a custom. None of this information is disclosed to us. If you desire more in-depth information please contact us for information on how you can make an appointment with our consultant)

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Published by: BioElectricShield on Nov 22, 2008
Copyright:Attribution Non-commercial

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08/04/2010

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Page 1 of 3 www.bioelectricshield.com Rev 03/09
BioElectric Shield Company
Custom Shield Information
How do I know if I would benefit from a custom shield?
 It costs nothing to find out. We need you to send a full body color photo, takenwith a regular film camera (not digital), and mail it to our office. Once we receive it, our consultant willbe able to see your aura, and what type of shield would best suit your needs. We will call, or email youback with their recommendations. It would be helpful if you filled out the form below to give usbackground.
How is a Custom Shield made?
We are fortunate to have a consultant who has the ability to perceive, in great detail, all the colors anddesigns that make up the energy field that surrounds any living thing (an aura). This gift has been passeddown through her family for 500 years. She studies each aspect of your aura and designs a gem matrixthat will work the best for you. She is meticulous in her design of your custom Shield.
How will a Custom Shield benefit me?
 Many people with special physical challenges, very sensitive energy, or demanding work environmentsfind a custom designed Shield makes an outstanding change for the better in their life. A custom Shieldis individualized for your maximum protection, strength, and balance. It will address your specificphysical, mental, and emotional needs at home, work or while traveling. It may also enhance yourperformance at work. This is an investment in your energetic well being that is immeasurable, and willlast for years.
What will a Custom Shield cost?
The cost is divided into 3 areas:1.
 
Individual customizing process - $350.00. This includes the fee to the consultant whodesigns your Shield as well as the phone and shipping logistics of having your Shield made.The consultant requires several hours to analyze your aura and select the correct type andcolor of gems that will most balance, strengthen and protect you. Your answers on thisquestionnaire are important because she will emphasize the areas that are the most importantto you.2.
 
A custom shield includes the basic matrix of gems, plus specifically chosen ones that willhelp you. You only pay for the additional gems. Approximate cost ranges between $40 -$100.3.
 
Type of Shield - Prices vary. You can choose a style you would like, or request that theconsultant recommend the best style for you. Please see our website athttp://www.bioelectricshield.com/products/productmain.html for current prices of variousshield styles.
Here's what we need from you:
1.
 
You may use a digital camera to take the photo. Please set on the finest resolution settingpossible (Very Fine or High). Please set your printer to print at the highest dpi available (someprinters will print up to 1400 dpi or higher.) The photo must be printed on photographic paper.You can use Kodak “Print” paper or an equivalent paper designed for printing digital photos.This will produce a very glossy print. Please make the image at least 4”x 5” in size. IF YOU DONOT HAVE A PRINTER with 6 color cartridges, to create a sharp enough image, you can sendyour photo to bioelectricacct@gmail.com,our Wisconsin office. Carolyn will print your photo and mail it in. The cost for this is $7 to cover paper, ink and mailing to Montana. To pay for this,please go back to the custom page and order the print.
 
Page 2 of 3 www.bioelectricshield.com Rev 03/09
2.
 
Please wear light or white clothing and have a photo of your entire body taken against at lightbackground. Please allow plenty of room above your head and below your feet.3.
 
A current photo (no older than 3 months) is necessary for accuracy. Please write your name onthe back of your picture.4.
 
Once you have decided you want a custom shield made, we will ask for custom shield deposit.Please call with a credit card, or send a check for $350. This starts the process. Next we sendyour photo to our consultant. When we get back her specifications, we may have to order specialgems for you. It may take up to 8-12 weeks to complete your order. We use only the bestquality gems, because the vibrational healing capacity is enhanced proportionally when the gemshave full, rich color and clarity.5.
 
If you have a Shield style preference, please make a check mark by it. Or you can request theconsultant to choose the styles that will be the most effective for you. If you chose this, we willcall you about her recommendations, and then you will make the final choice of Shield style thatwill contain your custom matrix.
Circle
your preference of style shield: All silver - Silver with Brass Tabs - Silver with Gold Tabs –All Gold
Circle
: satin or polished style OR _____Please ask the consultant to choose the best style
Custom Shield Questionnaire
Please answer the following questions: (Use another page if necessary)1. Describe your personal concerns. Please include why you are interested in having a Shielddesigned just for you.2. Please describe your home and work environments. Are you sensitive or concerned aboutanything in your environment? Are there any special circumstances such as high-tension power lines,microwave towers, etc?
 
Page 3 of 3 www.bioelectricshield.com Rev 03/09
Custom Shield Order Form (please print)
Name _________________________________________________________Address _______________________________________________________City / State / Zip _________________________________________________Phone Day _________________________Evening ______________________Email___________________________________________________________
Payment -
Check one:_____ Custom Inquiry only -- I just want to know if a Custom Shield is appropriate for me;don't design the Shield yet._____ Please design and make a customized Shield for me. Enclosed is my non-refundable deposit of $350.00Total Enclosed $_______Balance is due when your Custom Shield is designed and ready to be made.(If you used a credit card, we will bill your card. If you have paid by cash or check we will call you forthe balance prior to completion of your Shield.)_____ Enclosed please find my check for the deposit
Please sign the following disclaimer:
I understand that I am requesting a Custom Shield because it is my preference to have one that has beendesigned for me based on information I have shared freely. I understand that it will be designed tobenefit me in general. I understand that the Shield is not a medical device and is not intended for use inthe diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or the prevention of disease.Signed_____________________________________________ Date_______________________
Your Instructions: You will be sending information to 2 places.
Please
send your glossy photos and your page 2 answers
 BioElectric Shield CompanyProduct Manager26 Treeline Rd.Lavina, Mt. 59046.
Please send a copy of your page 2 questions and page 3
BioElectric Shield Co.8548 Wagner Creek RdTalent, Or. 97540.

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