Order
Page
( Typically, orders arrive
within 1-2 weeks to US addresses, 2-4 weeks elsewhere. )
Notes: Please include the extra shipping for orders outside the US. Otherwise, we must cancel your order. Place orders to Italy here.. Also, no orders from Korea please.
Or, Print, Fill out, and Mail or Fax the following form to
Peter H. Proctor, PhD, MD, 4126 SW Freeway, Suite 1616
Houston, Texas 77027
Office: 713-960-1616, FAX: 713-960-9307
1-800-926-1752 (Voice line for orders only)
Payment: We accept credit cards, checks, or
money orders in US currency only. Note:
Canadian and many European post offices sell US
dollar-denominated postal money orders. Please put
your email address on the money order. We also accept Western
Union International Money Grams ( fax or e-mail us the number
).
Name:________________________________________
Street Address___________________________________
City__________________________St.________ postal code______________
Country______________
Credit card #___________________________________________Expires________
Card Member's signature__________________________________
Phone__________________________________
Proxiphen-N (nonprescription ) 2 Months $59.95
________
4 Months supply $109.95 _________
NANO Shampoo 3 Months supply $39.95 _________
NANO Conditioner 2 Months supply $29.95
___________
NANO Shampoo and Conditioner $59.95_____________
($10 Price Savings)
Proxiphen ( Prescription ) 1 Month $100.00_____________
(Requires physican diagnosis---Read first )
*Shipping and Handling, US, $6.00________, Next day FEDEX or UPS to
US Destinations $25_____( No Saturday delivery). Also, we cannot guarantee next-day delivery. Sometimes either we or the shipper
are a little slow.
*Shipping to Europe or Asia is $25. Minimum order to Italy is $100 plus shipping )
Total ____________