FAX - order

Please send me the following number of boxes HORMOTEX^TM pills:

1 (one) box x 24 pills at US$ 20,00

3 (three) boxes x 24 pills at US$ 50,00

10 (ten) boxes x 24 pills at US$ 130,00

If you want more than 10 boxes please inquire!

Mailing Address:

Client confirms that he has full age.
Postage will be confidential in neutral parcels / envelopes mentioning sender only.

Payment:

• Bank cheque (+ extra cost US$ 10)
  
• Advanced cash in US$ notes by registered mail
  
• by Eurocard/Mastercard stating:

Number: Valid from: Expiry:            Beta-Phase Signature:

Place/Date of orderSignature


Please print this page and send it by fax, e-mail or mail with payment to:

Neomed Pharma GmbH
Moltkestr. 38
23564 Lübeck
Germany
Tel. ++49 451 795024
Fax ++49 451 792895
e-mail: neomed-robin@t-online.de