Fax Order Form - BIOVEA INDIA

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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: 022-66459707

Shipping Address

Title: Company:
First Name: Surname:
Address 1:
Address 2:
Town/Suburb: County:
Postal Code: Country:
Telephone: E-mail:
Product Name Qty. Price Subtotal
$ $
$ $
$ $
$ $
$ $
$ $
$ $
Shipping and Handling is ₹ 195 for all orders with a subtotal under ₹ 1,999.
Shipping and Handling is free over ₹ 1,999 !
SUBTOTAL: $
SHIPPING & HANDLING: $
ORDER TOTAL ($): $

Payment Method

 
Credit Card (Please complete the information below)
  Visa   MasterCard
 
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.