Mammorex Mail Order Form

Please fill out the form below!

Instructions For Mail Ordering

To pay by International Money Order you must follow these 4 simple steps:

1) Fill in the form below online (Or print out and complete in handwriting).

2) Print this form and attach the correct payment.

3) Payment MUST be made payable to Zudker Medical Group (All payments MUST be in US Dollars).

4) Send the form and your Money Order to the following address:

- Suite 126 -
883 Van Isle Way
Victoria BC
V9B 5R8
Canada

Please Enter Your Shipping Information


First Name:
Last Name:
Email Address:
Address Line 1
Address Line 2
Town/City
State
Post/Zip Code
Country
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

Price:
Shipping:

Total:

You may wish to send your mail order by regular mail. However, we do not take any responsibility for not receiving your mail order. We suggest sending mail orders via a tracking postal service.

Thank you for your Order!