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SECURE Order Form
for Mexican Customers

      
808-330-9781

HOW TO NAVIGATE THIS ORDER FORM:

Use the "Tab" key on your keyboard (located to the left of the letter "Q") OR use your mouse to move the cursor over each box and click on the left mouse button. Do NOT use the "Enter" key. Pressing the "Enter" key will submit this form to NATURE DOC regardless of whether you have finished entering all the information that you wanted or not!

NOTE: If you are a REPEAT customer, and you would like to use the same mailing address and payment information that you submitted previously, then select the products that you want to order and provide us with your name, e-mail address and phone number and we will take care of the rest. Please check the following box too:

I AM A REPEAT CUSTOMER!

ORDERING INFORMATION:

Quantity
SEACURE®, 180 capsules per bottle, 500 mg each.
SEAVIVE®, 90 capsules per bottle, 500 mg each.
INTESTIVE®, 120 capsules per box, 500 mg each.

Pricing for SEACURE® is as follows:

1 bottle for US $29.95,
2 bottles for US $57.90 (US $28.95 each),
3 bottles for US $83.85 (US $27.95 each),
4 bottles for US $107.80 (US $26.95 each), or
5 bottles for US $129.75 (US $25.95 each).

Pricing for SEAVIVE® and INTESTIVE® is as follows:

1 bottle or box for US $26.95,
2 bottles or boxes for US $51.90 (US $25.95 each),
3 bottles or boxes for US $74.85 (US $24.95 each),
4 bottles or boxes for US $95.80 (US $23.95 each) or
5 bottles or boxes for US $114.75 (US $22.95 each).


We will mix orders and give you the volume discount. For example, order 2 bottles SEACURE® of and 1 box of INTESTIVE® and receive all 3 for the price of US $80.85 (2 bottles of SEACURE® at US $27.95 each and 1 box of INTESTIVE® at US $24.95) with US Express Mail shipping for US $12.00.

CUSTOMER INFORMATION:

NOTE: All fields marked with an * are REQUIRED!

First Name *
Last Name *
e-mail address *
Address Line1 *
Address Line2
City *
State *
Postal Number *
MEXICO
Work Phone Number
Home Phone Number
Fax Phone Number

SHIPPING INFORMATION:

If you order 3, 4 or 5 bottles of SEACURE® or SEAVIVE® or 3, 4 or 5 boxes of INTESTIVE®, the cost for US Postal Service Express Mail delivery for you order is US $12.00 (delivery in 5 to 7 days). UPS Worldwide Express costs US $33.00 (delivery in 4 to 5 days).

If you order 2 bottles of SEACURE® of SEAVIVE® or 2 boxes of INTESTIVE®, the cost of US Postal Service Express Mail delivery for you order is US $15.00. UPS Worldwide Express delivery costs US $37.00.

If you order 1 bottle of SEACURE® or SEAVIVE® or 1 box of INTESTIVE®, the cost of US Postal Service Express Mail delivery for you order is US $18.00. UPS Worldwide Express delivery costs US $40.00.

We also offer US Postal Service International Air Mail delivery for your order. We do NOT recommend US Postal Service International Air Mail becuase it is NOT insured and cannot be traced! Delivery time is usually 3 to 4 weeks. The cost for US Postal Service International Air Mail delivery is US $10.00. You must accept ALL the risk associated with sending your order to you via US Postal Service International Air Mail. If your order is lost or damaged, you agree to pay us for your order!

What type of shipping do you want?


PAYMENT INFORMATION:

Credit Card Type: (select one)
Visa MasterCard American Express Discover
Credit Card Number:
Expiration Date:
Name of the person as it appears on the credit card:
(REQUIRED)

I DO NOT WANT TO PROVIDE MY CREDIT CARD INFORMATION ONLINE. I AM CALLING IN WITH MY PAYMENT INFORMATION!

Call 808-330-9781 to leave your credit card information.

Comments/Suggestions:


YOU MUST CLICK ON THE "Send Order" BUTTON TO COMPLETE YOUR PURCHASE!
Please click only once!

Please be patient! Sometimes the response is slow when internet traffic is heavy!

© 1999-2005 Seacure-Protein. All Rights Reserved. 808-330-9781
SEACURE® is a registered trademark of Proper Nutrition, Inc.

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