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:
NATURE
DOC
P.O. Box 1027
Pearl City, HAWAII 96782
USA
ORDERING INFORMATION:
Quantity
ACES + ZINC , 60 softgels, $12.95 each.
SCAR SO SOFT , 1 ounce (30 ml) bottle, $19.95 each.
SEACURE , 180 capsules, $29.95 each.
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* __________________________ _____________________________________
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. Priority Mail - $7.00 for up to 1 lb.
U.S. Express Mail - $18.80 for up to 1 lb.
PAYMENT INFORMATION:
You can pay for your order with your credit card OR with your 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. Include your check
with this form. Please make your check payable to NATURE
DOC . Do not forget to include the cost of shipping.
Return to ABOUT
SCARS & KELOIDS order
page in English for US Territories/Associations.