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 each.
SCAR SO SOFT, 1 ounce (30 ml) bottle, $19.95 each.
SEACURE, 180 capsules, $23.95 each.

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 (if available) ___________________________________________

SHIPPING INFORMATION:

We only offer US First Class Mail shipping at this time. Delivery times vary. The cost for US First Class Mail is $6.00 for up to 12 oz. All orders are insured.

PAYMENT INFORMATION:

You can pay for your order with any major credit card or by personal check (drawn on a US Bank).

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 (US Banks Only). Include your check with this form. Please make your check payable to NATURE DOC. Do not forget to include the cost of shipping.

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 ABOUT SCARS & KELOIDS order page in English for the US Military.