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MAIL Order Form
for US Territories/Associations

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 817-607-8531. Mail the completed form to us at the following address:

NATURE DOC
P.O. Box 777
Joshua, TX 76058
USA

ORDERING INFORMATION:

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

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 MAIL THE COMPLETED FORM TO US.

Return to SEACURE-PROTEIN order page for US Territories/Associations.

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SEACURE® is a registered trademark of Proper Nutrition, Inc.

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