Fax Order Page - Nutraelle DigestiveCare
   Check this box to print a blank form
Fax completed form to:
Attn: Sales Department
360-368-0260
  SHIPPING INFORMATION
First and Last Name:
Street Address 1:
Street Address 2:
City:   State/Province:
Zip Code:   Country:
Email Address:   Phone Number:
ORDER QUANTITY: Enter your quantity and the form will automatically calculate your total
Qty SKU Item Name Price Subtotal
NUTRE-01 Nutraelle DigestiveCare 1-month Supply $39.95 $0.00
NUTRE-03 Nutraelle DigestiveCare 3-month Supply $99.95 $0.00
NUTRE-06 Nutraelle DigestiveCare 6-month Supply (Buy 4 get 2 Free) $159.95 $0.00
SHIPPING - Order over $159.00 receive free ground shipping
USPS Standard Shipping - $6.95 UPS Next Day Air - $24.95
USPS International - $22.95 UPS 2nd Day Air - $14.95
USPS Priority Mail - $9.95
USPS Standard Shipping - $0.00 UPS Next Day Air - $24.95
USPS International - $22.95 UPS 2nd Day Air - $14.95
USPS Priority Mail - $9.95
Subtotal: $0.00
Shipping: $0.00
Total: 0.00
Fax completed form to: 360-368-0260
PAYMENT DETAILS
If you are paying by credit card, please fill in the required information below:
Card Number:
Card Expiration Date (MM/YY):
/ CVV2 Number: What is the CVV2 number?
Name as it appears on card:
Credit Card Street Address:
Credit Card City, State:
Credit Card Country:
Credit Card Zip Code:

Cardholder Signature:

Notes:
Please select the credit card type used for this order:
MasterCard
Visa
American Express
Discover Card
 
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