NATURE DOC

PGP Key SECURE International Order Form PGP Key
for VITALINE® Coenzyme Q10
VITALINE CoQ10

817-607-8531


We offer shipping via US Postal Service First Class Mail International to most of our international customers on our VITALINE® Coenzyme Q10 products ($15.00 USD, Canada $10.00 USD).

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 first and last 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:

We offer many different dosages and flavors of VITALINE® Coenzyme Q10. Please enter the number of bottles that you want in the box under "Quantity."

Please note that for the 1200 mg/day Parkinson's therapy, 1 bottle of the 300 mg wafers is a 15 day supply, whereas 1 bottle of the 400 mg wafers is a 1 month supply. We do offer monthly auto-ship for this product. Please check the information in the shipping section further down this web page.

Quantity
VITALINE® COQ10, 90 wafers, 400 mg CoQ10/wafer, ORANGE-FLAVOR with 200 IU Vitamin E/wafer. Price: $149.90 USD

VITALINE® COQ10, 90 wafers, 400 mg CoQ10/wafer, CHERRY/VANILLA-FLAVOR, NO Vitamin E! Price: $149.90 USD

VITALINE® COQ10, 60 wafers, 300 mg CoQ10/wafer, MAPLE-FLAVOR with 300 IU Vitamin E/wafer. Price: $74.95 USD

VITALINE® COQ10, 60 wafers, 300 mg CoQ10/wafer, MAPLE-FLAVOR, NO Vitamin E! Price: $74.95 USD

VITALINE® COQ10, 30 wafers, 200 mg CoQ10/wafer, CHOCOLATE-FLAVOR, NO Vitamin E! Price: 1-2 bottles $40.95 USD each, 3-5 bottles $37.95 USD each or 6 bottles at $34.95 USD each.

VITALINE® COQ10, 30 wafers, 200 mg CoQ10/wafer, MAPLE-FLAVOR with 400 IU Vitamin E/wafer. Price: 1-2 bottles $40.95 USD each, 3-5 bottles $37.95 USD each or 6 bottles at $34.95 USD each.

VITALINE® COQ10, 30 "tablets", 200 mg CoQ10/TABLET (NOT CHEWABLE!), NO Vitamin E. Price: 1-2 bottles $40.95 USD each, 3-5 bottles $37.95 USD each or 6 bottles at $34.95 USD each.

VITALINE® COQ10, 30 wafers, 100 mg CoQ10/wafer, CHOCOLATE-FLAVOR, NO Vitamin E! Price: 1-3 bottles $24.95 USD each or 4 or more bottles $21.95 USD each.

VITALINE® COQ10, 30 wafers, 100 mg CoQ10/wafer, MAPLE-FLAVOR with 300 IU Vitamin E/wafer. Price: 1-3 bottles $24.95 USD each or 4 or more bottles $21.95 USD each.

UBQH - Ubiquinol, 60 softgels, 50 mg Patented, Stabilzed, Reduced Ubiquinol/softgel. Price: $23.95 USD each.

UBQH - Ubiquinol, 60 softgels, 100 mg Patented, Stabilzed, Reduced Ubiquinol/softgel. Price: $34.95 USD each.

CUSTOMER INFORMATION:

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)
City *
State/Province/Region
Zip/Postal Code
Country *

Shipping Address (enter information only if different from billing address above):
First Name
Last Name
Address Line 1
Address Line 2 (optional)
City
State/Province/Region
Zip/Postal Code
Country

Contact Information (We do "NOT" share this information with 3rd parties!)
* (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.)

SHIPPING INFORMATION:

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 orders@naturedoc.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 orders@naturedoc.com 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!

PAYMENT INFORMATION:

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)
Visa MasterCard American Express Discover
Credit Card Number:
Expiration Date:
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):
(REQUIRED)

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.

Comments/Suggestions:


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



Vitaline® is a registered trademark of Integrative Therapeutics, Inc.
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817-607-8531 (Office)
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