Order Via Fax: 1-250-708-0046


Fax Order Form: 1-250-708-0046

Instructions For Fax Ordering

To pay via FAX please follow these 2 simple steps:

1) Fill in the form below including ALL your credit card and shipping details.

2) Print this form and send via fax to the following number:

Please Enter Your Credit Card Billing Information

Card Type:     
Card Number:
Expiration Date:
First Name: as appears on card
Last Name: as appears on card

Please Enter Your Shipping Information

First Name:
Last Name:
Email Address:
Address Line 1
Address Line 2
Post/Zip Code
Phone (optional)
Reference Number 16746

We recommend submitting a contact phone number as well as an email address. We may need to contact you in rare circumstances to verify your order. Contacting you by phone will expedite this process.

Please Select Your Mammorex Order

6 Month Supply - 6 Bottles - $299.95
5 Month Supply - 5 Bottles - $234.65 (4+1 FREE BEST VALUE)
3 Month Supply - 3 Bottles - $183.85
2 Month Supply - 2 Bottles - $128.95
1 Month Supply - 1 Bottle - $69.95

Please Select Your Shipping

US & Canada - $9.95
International - $13.95



Please send via fax to the following number: 1-250-708-0046

Thank you for your Order!