SinusWars · Order Form

Please print out this form, fill it in and fax it to us at 1-302-358-2980 in the US

First Name:

Surname:

Shipping
Address:

City:

State:

Zip Code:

Country:

Telephone:

Fax:

Email:

Please double check the email address. We need it to send a confirmation of the order.

Please supply me with the following SinusWars Remedies:
Please note that 1 unit consist of a six week supply unless specified otherwise.

Remedy

1 unit in US$

2 unit in US$

Totals in US$

SinusWars 1

39.95

75.00

SinusWars 2

39.95

75.00

SinusWars 4

39.95

75.00

SinusWars 5

39.95

75.00

SinusWars 6

39.95

75.00

SinusWars 7

39.95

75.00

SinusWars 8

74.95 (12 weeks supply)

140.00 (24 weeks supply)

SinusWars 9

39.95

75.00

SinusWars 10

39.95

75.00

SinusWars 11

39.95

75.00

SinusWars 12

39.95

75.00

SinusWars 13

74.95 (12 weeks supply)

140.00 (24 weeks supply)

SinusWars 14

39.95

75.00

SinusWars 15

39.95

75.00

SinusWars 16

39.95

75.00

SinusWars 17

74.95 (12 weeks supply)

140.00 (24 weeks supply)

SinusWars 19

39.95

75.00

Please choose a shipping method

USA SHIPPING METHODS (Shipped from the US)
		Total
USPS PRIORITY MAIL Shipping delivery within 3-10 days	$4.95
UPS Ground Shipping delivery within 3-6 days	$7.00
UPS 3 day shipping delivery within 2-5 days	$16.00
UPS Second day shipping delivery is 2 Business Days	$22.00
UPS Next Day shipping is 1 business day.	$40.00
International (Worldwide) Shipping methods
USPS delivery within 7-21 days	$12.50

Remedies Total

Shipping Cost

                                                                                             Total         $

Card Details

NAME ON CREDIT CARD:
CREDIT CARD TYPE:
CREDIT CARD NUMBER:
LAST 3 DIGITS OF NUMBER ON THE BACK OF YOUR CARD:
EXPIRATION DATE:	Month:	Year:
SIGNATURE:
DATE:
COMMENTS: