SinusWars · Order Form

Please print out this form, fill it in and fax it to us at 1-302-358-2980 in the US

We do not accept cash, international/foreign money orders or checks.
Please do not send us these or we will have to send them back.

First Name:

Surname:

Shipping
Address:

City:

State:

Zip Code:

Country:

Telephone:

Fax:

Email:

Please double check the email address. We need it to send a confirmation of the order.

Please supply me with the following SinusWars Remedies:
Please note that 1 unit consist of a six week supply unless specified otherwise.

Remedy

1 unit in US$

2 unit in US$

Totals in US$

SinusWars1

$35.00

$65.00

SinusWars2

$30.00

$65.00

SinusWars4

$30.00

$55.00

SinusWars30

$30.00

$55.00

SinusWars7

$35.00

$65.00

SinusWars70

$35.00

$65.00

SinusWars8

$59.95 (12 weeks supply)

$109.90 (24 weeks supply)

SinusWars9

$35.00

$65.00

SinusWars10

$30.00

$55.00

SinusWars11

$35.00

$65.00

SinusWars13

$59.95 (12 weeks supply)

$109.90 (24 weeks supply)

SinusWars14

$35.00

$65.00

Please choose a shipping method for the USA

USA SHIPPING METHODS (Shipped from the US)
		Total
USPS PRIORITY MAIL- Shipping delivery within 3-10 days	$5.95
3 day Priority - shipping delivery within 3-4 days	$9.95
Next Day Shipping - Shipping delivery within 1-2 days	$35.00

Remedies Total

Shipping Cost

                                                                                             Total         $

Card Details

NAME ON CREDIT CARD:
CREDIT CARD TYPE:
CREDIT CARD NUMBER:
LAST 3 DIGITS OF NUMBER ON THE BACK OF YOUR CARD:
EXPIRATION DATE:	Month:	Year:
SIGNATURE:
DATE:
COMMENTS: