Print out this form using your browser, then fill in the information needed to place your order. Mail the completed form to us at the following address:

ORDERING INFORMATION:

Quantity
ACES + ZINC, 60 softgels, $12.95 USD each.
SCAR SO SOFT, 1 ounce (30 ml) bottle, $19.95 USD each.
SEACURE, 180 capsules, $23.95 USD each.

CUSTOMER INFORMATION:

NOTE: All fields marked with an * are REQUIRED!

First Name:* ______________________________________________________________

Last Name:* ______________________________________________________________

e-mail address* ____________________________________________________________

Address Line1* ____________________________________________________________

Address Line2 _____________________________________________________________

City* ____________________________________________________________________

Province/Territory* _________________________________________________________

Postal Code* _____________________________________________________________

CANADA

Work or Home Phone Number _______________________________________________


SHIPPING INFORMATION:

What type of shipping do you want (Please fill in) ?

_______________________________________________________________________

Shipping & Handling Costs are as follows:

U.S. Express Mail - usually 4 to 5 day delivery time, $24.00 USD for up to 8 ounces (0.23 kg, 1-2 bottles), $28.00 USD for 1 pound (0.45 kg, 3-5 bottles).
U.S. Air Mail - usually 7 to 10 day delivery time, $6.00 USD for up to 1 pound (0.45 kg, 1-5 bottles).

PAYMENT INFORMATION:

You can pay for your order with your credit card OR you can pay by personal check.

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):

_________________________________________________________________________

PERSONAL CHECK PAYMENTS

Check this box if you are paying by personal check. Please make the check payable to NATURE DOC. Do not forget to include the cost of shipping. Include your check with this form when you mail it to NATURE DOC. There is a $25.00 USD NSF Fee for returned checks.

Comments/Suggestions:

Return to ABOUT SCARS & KELOIDS order page in English for Canada.