Sinus-Pro.com · 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 Sinus-Pro Remedies:
Please note that 1 unit consist of a
30 day supply unless specified otherwise.
Please take note of discounted prices offered on the website should you wish to order more than 1 unit.

Units

Remedy

Price per unit in US$

Totals in US$

  1

Chronic Sinusitis Remedy (84 day supply)

62.00

 

  1

Fungus Allergy Remedy

28.00

 

  1

General Sinusitis Remedy

28.00

 

  1

Halitosis (Bad Breath) Remedy

28.00

 

  1

Hayfever & Allergy Remedy

28.00

 

  1

Nasal Polyps Remedy (84 day supply)

62.00

 

  1

Post Nasal Drip Remedy

28.00

 

  1

Rhinitis Remedy

28.00

 

  1

Sinus Headache Remedy

28.00

 

  1

Sinus Pressure Remedy

28.00

 

  1

Sinus Stress Remedy

28.00

 


Please choose a shipping method

USA SHIPPING METHODS (Shipped from the US)

 

 

Total

USPS PRIORITY MAIL Shipping delivery within 3-10 days

$5.00

 

UPS Second day shipping delivery is 2 Business Days

$22.00

 

UPS Next Day shipping is 1 business day.

$35.00

 

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:

 

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