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SupraHealth: Online Order Form
 

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Please visit our new website:  www.suprahealth.net

Online Order Form

  • Please use the secure form below to place an online order. Your credit card will be charged at the time of shipment. Orders are normally shipped UPS Ground. There is a flat $5.00 shipping charge for orders going UPS Ground, but there is no charge for orders over $100.00 placed online going to the contiguous 48 states (not Alaska or Hawaii). Sorry, but we do not take international orders due to import restrictions.
     
  • For new customers, you receive one free copy of The Nutraceutical Reference Guide. Orders for additional copies must be placed by phone, fax, or mailed in.
  ► Products Ordered
  SupraCaps
   
  Borage Oil
   
  C-500 Complex
   
  Phosphatidyl Serine
   
  The Pill Bag
   
  Ultra Omega-3
   
  ► Billing Info
Name
Address
City
State
Zip
Telephone
Email
  ► Shipping Info (if different from Billing Info)
Name
Address
City
State
Zip
Ship Via  
  ► Delivery Signature Required? (Y/N)
   
  ► Credit Card Info
Type
Number
Expiration Date
CVV*

 *3 numbers if V/MC and on back;


 *4 numbers if Amex and in front.

   
  ► Comments/Questions?
 

PLEASE READ: If, after you click the "Submit Order" button below, you get the "Form Validation Error" message, use the back arrow of your browser to return to the form. Otherwise, if you click on "Return to the form", you will be returned to a blank form and will have to start over.

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Copyright © 2003 SupraHealth, Inc.
Last modified: 10/17/12