Velvet Orders

Please print this order form, complete it and fax it to us.

Ordered By:
Ship To:
Name:Name
# Road/Street:
UPS requires the above
# Road/Street:
UPS requires the above
Mailing Address:Mailing Address:
City/Town/ZipCity/Town/Zip
State or Province:State or Province:
Country:Country:
Telephone:Telephone:
E-mail:E-mail:

 QTYPRICETOTAL PRICE
30 capsules (2 btl. min.) $36.20 
60 capsules $35.00 
90 capsules $51.00 
120 capsules $65.00 
150 capsules $79.00 
200 capsules $104.00 
500 capsules $275.00 
1000 capsules $510.00 

Shipping and Handling: (USA:$4.00, International:$6.00)