no-s-button.gif (8559 bytes)Life Pharma

HomeOrderFeedbackSearch

Order our products on-line secure SHOPPING CART. All orders processed within one business day and shipped via the Postal Service.

  • When the SHOPPING CART is broken you may order on this secure link:
  • To order Hydrazine Sulfate 30mg 100cp click on the link below:
When the order form is broken you may order 30mg Hydrazine Sulfate on this link:
  • To order Hydrazine Sulfate 60mg 100cp click on the link below:
When the order form is broken you may order 60mg Hydrazine Sulfate on this link:
  • To order MOOMIYO, MUMIE 20tb click on the link below:
When order form is broken you may order MOOMIYO,MUMMIE 20Tb on this link:

  • You may also print and FAX this order form:

    TEMPORARY O R D E R F O R M

    Use this order for only if the SECURE SHOPPING CART is broken.

    This form you must print and Fax to: 1 604 856 - 3108

    

Name:       

    Street Address:   
    City:    Prov/State: Postal ZIP Code:

Country:
    Area Code:    Phone # : 
    

    Area Code:  Fax # : 
    
  
    
 




    


    
Item#Name :Quantity:  $ Price: 

Item#Name :Quantity:  $ Price:  

Item#Name :Quantity:  $ Price: 

PRIORITY    POST     # : US$1.00 Price: 

EXPRESS   MAIL      # :US$15.00 Price: 

FEX EX OVERNIGHT# :US$30.00 Price: 


    Sub Total:


    Canadian Residents Add  7 %  GST  TAX : 


     T O T A L: 
    
CREDIT CARD# :EXP.DATE:  

Name on CREDIT CARD# :      

Comments :   

    PRINT THIS ORDER FORM AND FAX TO 1 604 856-3108
    
 
    CLICK HERE TO RETURN TO LIFEPHARMA