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FAX Order Form
for US Customers

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 1-800-952-5884 or 817-645-4134. Fax the completed form to us at 817-977-1240. 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.
containers of SEACURE® for pets, 100 grams with scoop.
containers of SEACURE® for pets, 500 grams without scoop.
containers of SEACURE® for pets Chewables, 120 chewable tablets.

Pricing for SEACURE® is as follows:

1 bottle for $23.95,
2 bottles for $47.90 ($23.95 each),
3 bottles for $71.85 ($23.95 each),
4 bottles for $91.80 ($22.95 each),
5 bottles for $109.75 ($21.95 each) or
12 bottles (1 case) for $251.40 ($20.95 each).

Pricing for SEAVIVE® and INTESTIVE® is as follows:

1 bottle or box for $23.95,
2 bottles or boxes for $47.90 ($23.95 each),
3 bottles or boxes for $71.85 ($23.95 each),
4 bottles or boxes for $91.80 ($22.95 each),
5 bottles or boxes for $109.75 ($21.95 each) or
12 bottles or boxes (1 case) for $251.40 ($20.95 each).

Pricing for SEACURE® for pets, 100 gram containers and SEACURE® for pets Chewables, 120 chewable tablet containers is as follows:

1 or more containers for $23.95 each.

Pricing for SEACURE® for pets, 500 gram containers is as follows:

1 or more containes at $99.95 each. We do NOT offer volume or case discounts for the 100 or 500 gram containers of SEACURE® for pets.

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 $71.85 (2 bottles of SEACURE® at $23.95 each and 1 box of INTESTIVE® at $23.95) with FREE shipping via US PRIORITY MAIL!

SHIPPING INFORMATION:

We offer FREE shipping for customers in the USA! Delivery times average 2 to 4 days to most addresses.

If you want to upgrade to UPS GROUND, UPS 2ND DAY AIR, UPS NEXT DAY AIR OR US EXPRESS MAIL, please call us at 1-800-952-5884 for a price quote.

CUSTOMER INFORMATION:

NOTE: All fields marked with an * are REQUIRED!

First Name:* ______________________________________________________________

Last Name:* ______________________________________________________________

e-mail address* ____________________________________________________________

Address Line1* ____________________________________________________________

Address Line2 _____________________________________________________________

City* ____________________________________________________________________

State* ___________________________________________________________________

Zip Code* _______________________________________________________________

USA

The address above is a (Check one please):
____ Business Address ______ Residential Address

Work Phone Number _______________________________________________________

Home Phone Number _______________________________________________________

Fax Phone Number _________________________________________________________

PAYMENT INFORMATION:

You can pay for your order with your credit card OR from your checking account. Do not forget to include the cost of shipping if you are upgrading the shipping that you want for your order.

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):

________________________________________________________________________


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 (817)977-1240.

Return to SEACURE-PROTEIN order page for US customers.

© 1999-2009 Nature Doc. All Rights Reserved.
1-800-952-5884 or 817-645-4134.
SEACURE®, SEAVIVE®, INTESTIVE®, and SEACURE® for Pets are registered trademarks of Proper Nutrition, Inc.

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