NATURE DOC

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

817-607-8531


We offer FREE shipping via US First Class Mail for small orders and FREE shipping via US Priority Mail for larger orders to customers in the U.S.A.

INTERNATIONAL ORDERS (all countries outside the US) - Please click here ->International order form!

Use your mouse or the TAB key to move from box to box on this form. Do NOT use the "Enter" key!

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

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

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

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

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

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

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

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

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

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

UBQH - Ubiquinol, 60 softgels, 100 mg Patented, Stabilzed, Reduced Ubiquinol/softgel. Price: $34.95 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 * (TIP: Type the first letter of your state to jump down the list!)
Zip Code *
 USA

Shipping Address (enter information only if different from billing address above):
First Name *
Last Name *
Address Line 1 *
Address Line 2 (optional)
City *
State * (TIP: Type the first letter of your state to jump down the list!)
Zip Code *
 USA

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

Work Phone Number (We need 1 phone number!)
Home Phone Number

SHIPPING INFORMATION:

We offer FREE shipping via US Mail for all of our VITALINE CoQ10 products to customers in the U.S.A. Average delivery time is 4 to 5 days for US First Class Mail and 2 to 3 days for US Priority Mail. If you need expedited (UPS 2nd Day Air or US Express Mail) for your order, please call us at (817)607-8531.

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 call us 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 check or money order, please mail your payment to our address listed at the bottom of this web page. Make your check or money order payable to NATURE DOC. Please write what you are ordering (1 bottle of Vitaline CoQ10, 100 mg, please indicate flavor) on your payment. All first-time customers that pay by check -> We will have to place a hold on the shipping of your order until your check clears our bank. Average time for this is 5 to 7 business days. If you pay by money order, we can usually ship your order within 24 hours (excluding weekends).

CREDIT CARD PAYMENTS

Credit Card Type: (select one)
Visa MasterCard American Express Discover
Credit Card Number:
Expiration Date:
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 or by check, 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!

Comments/Suggestions:


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



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P.O. Box 777 Joshua, TX 76058-0777 USA
1-800-952-5884 or 817-607-8531
info@naturedoc.com