Fax Order: Payment by credit card is accepted by fax.
Please fax completed form to (661) 298-7072.
Mail Order: Payment by check, money order, and credit
card are accepted by mail. For international orders, please pay by money
order or cashier's check only. Please make checks or money orders payable
in US dollars to Nutrica, Inc. and mail to:
Nutrica, Inc. Attn: Mail Order
26893 Bouquet Canyon Rd. Ste. C210
Santa Clarita, CA 91350
| Billing Information | Shipping Information (if different) | ||
| Name | _________________________ | Name | _________________________ |
| Address | _________________________ | Address | _________________________ |
| _________________________ | _________________________ | ||
| City | _________________________ | City | _________________________ |
| State | _________________________ | State | _________________________ |
| Zip / Postal Code | _________________________ | Zip / Postal Code | _________________________ |
| Country | _________________________ | Country | _________________________ |
| _________________________ | _________________________ | ||
| Telephone | _________________________ | Telephone | _________________________ |
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| Credit Card Information | |||
| Number | _________________________ | Type: | Visa M/C Amex Discover |
| Expiration | _________________________ | Signature: | _________________________ |
| Quantity |
Product |
Price |
Total |
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ActivClear - Fast acting natural anti-acne cream | $11.10 |
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__________ |
Advaslim - Appetite suppressant & portion control supplement | $31.10 |
__________ |
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Hemaron - Relieves the symptoms of hemorrhoids | $33.32 |
__________ |
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Libilov - Clinically proven sexual performance enhancer for men. | $33.32 |
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Nutrave Crème - Anti-cellulite cream | $38.88 |
__________ |
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Prevedia - Relieves the symptoms of menopause | $33.32 |
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Psoriacream - Natural cream for psoriasis & eczema | $44.44 |
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Retane - Topical solution proven to stop hair loss & shedding | $38.88 |
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Venarin Suppl. - Leg vein formula for spider & varicose veins | $33.32 |
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Venarin Crème - (Regular Strength) Cream for varicose veins | $38.88 |
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VenarinMax Crème - (Max Strenght) Cream for spider veins | $44.44 |
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Venarin Suppl & Crème Combo - Save 5% | $68.59 |
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Venarin Suppl & Max Creme Combo - Save 5% | $73.87 | __________ |
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| California residents only, please add Sales Tax (8.25%) | __________ |
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| Shipping and Handling (Intl. orders, please add $8: | S / H |
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| Shipped via UPS Ground to most destinations and US Postal Mail for PO Boxes and International orders. Your order will be shipped in a discreet, unmarked box. | |||||||||||||||||||||
TOTAL |
__________ |
Questions? Call (800) 278-8002 (PST) or visit www.nutrica.com for Internet
only specials. Thank you for your order, we appreciate your business!
Prices subject to change without notice. International price excludes any applicable customs or duties.