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 _________________________
       
E-mail _________________________ E-mail _________________________
Telephone _________________________ Telephone _________________________
Credit Card Information  
Number _________________________ Type: Visa    M/C     Amex   Discover
Expiration _________________________ Signature: _________________________
 
Quantity
Product
Price
Total
__________
ActivClear - Fast acting natural anti-acne cream
$11.10
__________
__________
Advaslim - Appetite suppressant & portion control supplement
$31.10
__________
__________
Hemaron - Relieves the symptoms of hemorrhoids
$33.32
__________
__________
Libilov - Clinically proven sexual performance enhancer for men.
$33.32
__________
__________
Nutrave Crème - Anti-cellulite cream
$38.88
__________
__________
Prevedia - Relieves the symptoms of menopause
$33.32
__________
__________
Psoriacream - Natural cream for psoriasis & eczema
$44.44
__________
__________
Retane - Topical solution proven to stop hair loss & shedding
$38.88
__________
__________
Venarin Suppl. - Leg vein formula for spider & varicose veins
$33.32
__________
__________
Venarin Crème - (Regular Strength) Cream for varicose veins
$38.88
__________
__________
VenarinMax Crème - (Max Strenght) Cream for spider veins
$44.44
__________
__________
Venarin Suppl & Crème Combo - Save 5%
$68.59
__________
__________
Venarin Suppl & Max Creme Combo - Save 5% $73.87
__________

California residents only, please add Sales Tax (8.25%)
__________
Shipping and Handling (Intl. orders, please add $8:
S / H
__________
$0-$14.99
$5
$80-$119.99
$12
$150-$199
$16
$15-$49.99
$8
$120-$149.99
$14
$200 & up
$18
$50-$79.99
$10
 
 
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
__________
 
Where did you hear about us? _______________________________________________________________________
Notes: _________________________________________________________________________________________


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.