Seacure Protein US Territories/Associations Fax Order Form

FAX Order Form
for US Territories/Associations

Print out this form using your browser, then fill in the information needed to place your order. 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 US $23.95 with FREE shipping via US First Class Mail,
2 bottles for US $47.90 ($23.95 each) with FREE shipping via US First Class Mail,
3 bottles for US $71.85 ($23.95 each) with FREE shipping via US Priority Mail,
4 bottles for US $91.80 ($22.95 each) with FREE shipping via US Priority Mail,
5 bottles for US $109.75 ($21.95 each) with FREE shipping via US Priority Mail.

Pricing for SEAVIVE® and INTESTIVE® is as follows:

1 bottle or box for US $23.95 with FREE shipping via US First Class Mail,
2 bottles or boxes for US $47.90 (US $23.95 each) with FREE shipping via US First Class Mail,
3 bottles or boxes for US $71.85 (US $23.95 each) with FREE shipping via US Priority Mail,
4 bottles or boxes for US $91.80 (US $22.95 each) with FREE shipping via US Priority Mail or
5 bottles or boxes for US $109.75 (US $21.95 each) with FREE shipping via US Priority Mail.

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 containers at $99.95 each.

We do NOT offer volume discounts for the SEACURE® for pets products.

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 $71.85 (2 bottles of SEACURE® at US $23.95 each and 1 box of INTESTIVE® at US $23.95) 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 _____________________________________________________________

City* ____________________________________________________________________

Country* _________________________________________________________________

Zip Code* ________________________________________________________________

Contact Phone Number (if available) ____________________________________________

PAYMENT INFORMATION:

You can pay for your order with your credit card (VISA, MasterCard, American Express or Discover).

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 Territories/Associations.