Order FormPrint this Form and Fax or Mail to: |
 Advanced Colloidal Silver Nano Particle Technology™ |
Voice: 1-800-324-8674or (210) 858-5017 Fax: 1-888-505-5552 |
Vita Research Corporation 19141 Stone Oak Pkwy Ste 104 San Antonio, TX 78258 |
Billing Address: |
Shipping (if different): |
| Name: | Name: |
| Address: | Address: |
| City: | City: |
| State/Zip: | State/Zip |
| Phone: | Phone: |
| e-mail: | e-mail: |
| Qty. | Prod. No. | Description | Sug. Retail |
Price Ea. | TOTAL |
|---|---|---|---|---|---|
| 5500 | SILVERUM 8oz. (30ppm) | Buy 1 at $19.95 | |||
| 5500 | SILVERUM 8oz. (30ppm) | Buy 3 at $18.00 ea. (3 Bottles = $54.00) |
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| 5500 | SILVERUM 8oz. (30ppm) | Buy 12 at $17.50 ea. (12 Bottles = $209.95) |
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SHIPPING PRICE CHART (USA ONLY): U.S. Priority Mail: From(USD) To(USD) Rate(USD) $0.01 to $19.95 = $6.00 $19.96 to $54.00 = $12.00 $54.01 to $209.95 = $18.00 $209.96 to $400.00 = $33.00 $400.01 and up = $60.00 |
SUBTOTAL | ||||
| SHIPPING: See Price Chart | |||||
| Sales Tax | 0.00 | ||||
| TOTAL | |||||
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*Please make check or money order payable to: VITA RESEARCH CORPORATION |
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| EXPIRATION DATE | ||
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| © Vita Research Corporation | Effective Date: 08/27/2011 |