FAX Order
Form
for US Military
Print out this form using the print option under the file menu of your browser (top left corner of your browser window), then fill in the information needed to place your order. If you have any questions about this form, give us a call at 808-218-1811. Fax the completed form to us at (808)356-0166. We will process it right away and send your order to you within 24 hours (excluding weekends).
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 $29.95 with FREE
shipping via US First Class Mail,
2 bottles for $57.90 ($28.95 each)
with FREE
shipping via US Priority Mail,
3 bottles for $83.85 ($27.95 each)
with FREE
shipping via US Priority Mail,
4 bottles for $107.80 ($26.95 each)
with FREE
shipping via US Priority Mail,
5 bottles for US $129.75 ($25.95 each)
with FREE
shipping via US Priority Mail.
Pricing for SEAVIVE®
and INTESTIVE®
is as follows:
1 bottle or box for $26.95 with FREE
shipping via US First Class Mail,
2 bottles or boxes for $51.90 ($25.95
each) with FREE
shipping via US Priority Mail,
3 bottles or boxes for $74.85 ($24.95
each) with FREE
shipping via US Priority Mail,
4 bottles or boxes for $95.80 ($23.95
each) with FREE
shipping via US Priority Mail or
5 bottles or boxes for $114.75 ($22.95
each) with FREE
shipping via US Priority Mail.
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 $80.85
(2 bottles of SEACURE®
at $27.95 each and 1 box of INTESTIVE®
at $24.95) with FREE
shipping via US Priority Mail!
CUSTOMER INFORMATION:
NOTE: All fields marked with an *
are REQUIRED!
First Name:* ______________________________________________________________
Last Name:* ______________________________________________________________
e-mail address* ____________________________________________________________
Address Line1* ____________________________________________________________
Address Line2 _____________________________________________________________
Military Post Office*
________________________________________________________
Military State* ____________________________________________________________
Zip Code* _______________________________________________________________
Contact Phone Number _____________________________________________________
PAYMENT INFORMATION:
You can pay for your order with your credit card OR from your checking
account.
CREDIT CARD PAYMENTS
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):
________________________________________________________________________
CHECKING ACCOUNT PAYMENTS
You can pay for your order with funds from your checking account. Just
enter the information "EXACTLY" as it appears on your check into the boxes
below. We will "cut a check" using the information you provide
and send you a copy of it with your order.
Saves time! Saves money (no stamp)! No need to write and mail us your
check. Just as fast as using a credit card! Your order is shipped right
away.
If you have trouble locating the information that is needed for the form
below, please take a look at the sample check below this form for some
additional help.
PLEASE NOTE: All checks returned due to Non-Sufficient Funds (NSF)
will be charged a $25.00 NSF Fee! Also, please void the check that you
use so that you do not use the same check number twice!
|
Your name Your address City State Zip code |
Check # ABA # The ABA # is located close to your check # and looks like this 01-5678/1234 |
|
Pay To The Order Of NATURE
DOC |
|
The sample check below provides some additional help for locating the information needed in the above form.
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 US Military.
© 1999-2006 Seacure-Protein. All Rights
Reserved. 808-218-1811
SEACURE® is a registered trademark
of Proper Nutrition, Inc.
feedback@seacure-protein.com
