ORDERING INFORMATION:

Quantity
bottles of SEACURE®, 180 capsules per bottle, 500 mg each.
bottles of SEAVIVE®, 90 capsules per bottle, 500 mg each.
boxes of INTESTIVE®, 120 capsules per box, 500 mg each.

Pricing for SEACURE® is as follows:

1 bottle for US $29.95,
2 bottles for US $57.90 (US $28.95 each),
3 bottles for US $83.85 (US $27.95 each),
4 bottles for US $107.80 (US $26.95 each), or
5 bottles for US $129.75 (US $25.95 each).

Pricing for SEAVIVE® and INTESTIVE® is as follows:

1 bottle or box for US $26.95,
2 bottles or boxes for US $51.90 (US $25.95 each),
3 bottles or boxes for US $74.85 (US $24.95 each),
4 bottles or boxes for US $95.80 (US $23.95 each) or
5 bottles or boxes for US $114.75 (US $22.95 each).

We will mix orders and give you the volume discount. For example, order 2 bottles SEACURE® of and 1 box of INTESTIVE® and receive all 3 for the price of US $80.85 (2 bottles of SEACURE® at US $27.95 each and 1 box of INTESTIVE® at US $24.95) with US Express Mail shipping for US $20.00.

CUSTOMER INFORMATION:

NOTE: All fields marked with an * are REQUIRED!

First Name:* ______________________________________________________________

Last Name:* ______________________________________________________________

e-mail address*____________________________________________________________

Address Line1*____________________________________________________________

Address Line2 _____________________________________________________________

City*____________________________________________________________________

County, State or Province (If Applicable) ________________________________________

Postal Code/ Number (If Applicable) ___________________________________________

Country* _______________________________________________________________

Work or Home Phone Number ______________________________________________


SHIPPING INFORMATION:

If you order 3, 4 or 5 bottles of SEACURE® or SEAVIVE® or 3, 4 or 5 boxes of INTESTIVE®, the cost for US Postal Service Express Mail delivery for you order is US $20.00 (delivery in 5 to 7 days). UPS Worldwide Express delivery costs US $40.00 (delivery in 4 to 6 days).

If you order 2 bottles of SEACURE® or SEAVIVE® or 2 boxes of INTESTIVE®, the cost of US Postal Service Express Mail delivery for you order is US $25.00.

If you order 1 bottle of SEACURE® of SEAVIVE® or 1 box of INTESTIVE®, the cost of US Postal Service Express Mail delivery for you order is US $28.00.

We also offer US Postal Service International Air Mail delivery for your order. We do NOT recommend US Postal Service International Air Mail becuase it is NOT insured and cannot be traced! Delivery time is usually 3 to 4 weeks. The cost for US Postal Service International Air Mail delivery is US $10.00. You must accept ALL the risk associated with sending your order to you via US Postal Service International Air Mail. If your order is lost or damaged, you agree to pay us for your order!

Please select the type of shipping that you want for your order:

US Postal Service Express Mail,
UPS Worldwide Express,
US Postal Service International Air Mail ( I agree to accept ALL risk for loss or damage!)

PAYMENT INFORMATION:

Credit Card Type: (fill in one circle)
Visa MasterCard American Express Discover

Credit Card Number: ______________________________________________________

Expiration Date (Month/Year): ______________________________________________

Name of the person as it appears on the credit card (REQUIRED):

_______________________________________________________________________

Comments/Suggestions:

USE THE PRINT OPTION ON YOUR BROWSER TO PRINT A COPY OF THIS FORM. FILL IT IN AND FAX THE COMPLETED FORM TO US AT 808-356-0166.

Return to SEACURE-PROTEIN order page for International customers.

© 1999-2006 Seacure-Protein. All Rights Reserved. 808-218-1811
SEACURE® is a registered trademark of Proper Nutrition, Inc.
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