Nutrimed Labs Printable Order Form

	To Order Online simply select the product or products from the Online Catalog, type the quantity ordered into the order window and click the Add to Cart button.
	To Order by Mail simply fill in the appropriate blanks in the form below, then print the form with the print funtion of your web browser. Fields labeled in red are required.
	To Order by Phone call toll-free 1-800-687-1833 To Fax your Order 800-687-1836
	If you are ordering DermaCapTM, please use the DermaCapTM Order Form

PRINT & MAIL ORDER FORM

Name:

Address 1:

Address 2:

City / State / Zip:

Country:

Email:

Phone:

Fax:

Comment:

Nutritional Products
Quantity	Product Code and Name	Unit Price	Total Price

Payment Information

Payment:

Credit Card Number:

Expiration Date

CVV number required

What is a CVV number?

Send a printed catalog?

Yes No

MAIL TO: Nutrimed Labs, Inc., 7200 N. State Highway 161, Suite 110, Irving, TX, 75039

NOTE: We will calculate the 20 Percent Off or Buy Two Get One Free discount when we receive and process your order. This discount is not reflected in the total provided by the shopping cart.