NOTE: All fields marked with an
* are REQUIRED!
Billing Address for your credit card:
First Name *
Last Name *
Address Line 1 *
Address Line 2 (optional)
Shipping Address (enter information only if different from billing address above):
Address Line 1
Address Line 2 (optional)
Contact Information (We do "NOT" share this information with 3rd parties!)
e-mail address * (will send an e-mail confirmation of your order)
Home/Work Phone Number * (We need 1 contact phone number!)
Optional Contact Phone Number (Cell phone, etc.)
We offer shipping via US Postal Service First Class Mail International to most of our international customers on our VITALINE® Coenzyme Q10 products ($14.00 USD, Canada $10.00 USD). Average delivery time is 12 to 15 days.
If you need expedited (UPS Worldwide Express or US Postal Service Global Express Mail shipping) for your order, please e-mail us at email@example.com.
If you want the same order shipped to you each month automatically (so you don't have to remember to call in to place your order or use the internet to place your order), then check the box below, and we will
add you to our auto-ship list. We will ship the same order to you on the same day each month. If you decide later that you do not want auto-shipment of your order, then e-mail us at
firstname.lastname@example.org at least a week before your order ships and we will remove you from our auto-ship list.
PLEASE ADD ME TO YOUR MONTHLY AUTO-SHIP LIST!
If you want to pay by international money order, please mail your payment to our address listed at the bottom of this web page. Make your international money order payable to NATURE DOC. Please write what you
are ordering (i.e. 1 bottle of Vitaline® CoQ10, 100 mg, please indicate flavor) plus your name, address and phone number on a piece of paper and include it with your payment. If you include your e-mail address,
we will e-mail you to let you know that your order has been processed and shipped to you.
CREDIT CARD PAYMENTS
Credit Card Type: (select one)
Credit Card Number:
Credit Card Verification Code:
(3 digit code on the back of credit card for VISA, Mastercard and Discover; for AMEX it is the 4 digit code on the front of the credit card)
Name of the card holder as it appears on the credit card (Not the
name of the bank):
If you are paying with a credit card, but you prefer calling
this information in rather than submitting it online via this SECURE
ENCRYPTED form, then leave credit card information above blank, check
the box below, and click on the "Send Order" button at the
bottom of this page.
I AM CALLING IN WITH MY PAYMENT INFORMATION!
Call 1(817)607-8531 to leave your credit
card or checking account information. If you reach
our recording, then we are on the phone with another customer. Please
leave your name and phone number and we will call you back when we are
done with the other customer.
YOU MUST CLICK ON THE "Send Order" BUTTON TO COMPLETE YOUR PURCHASE!
Please click only once!
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