Fax Order Form - BIOVEA CANADA - ENGLISH
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Order Form

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Please fill out the form below completely and accurately to ensure fast processing of your order.

For your convenience, you may type your information before printing, or print the form and fill it out manually.

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Fax Number: 1-800-961-4750

Shipping Address

Title: Company:
First Name:Surname:
Address 1:
Address 2:
City/Town:State/Province/Region:
Postal Code:Country:
Telephone:E-mail:
Product NameQty.PriceSubtotal
$ $
$ $
$ $
$ $
$ $
$ $
$ $
Shipping and Handling is $4.95 for all orders with a subtotal under $49.00.
Shipping and Handling is free over $49.00!
Excludes Northwest Territories, Nunavut and Yukon
SUBTOTAL:$
SHIPPING & HANDLING:$
ORDER TOTAL (CAD$):$

Payment Method


Credit Card (Please complete the information below)
  Visa   MasterCard   American Express
 
Name on Card:
Card Number:
Expiry: -
Security Code: Visa/Mastercard is a 3-digit number
on the back of the card
Signature:_______________________________
Date: - -
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This Item Qualifies for
50% Off any 2nd Product!

Choose a regularly priced product and get a 2nd DIFFERENT
Item of equal or lesser value at 1/2 price.

*2nd Item must be a DIFFERENT product than 1st Item.
Excludes sale or promotional items and cannot be
combined with any other offers.