Dermazinc Secure Order Form

Order Form

DERMAZINC SECURE ORDER FORM

To order DermaZinc by phone
call our customer service at :

1-888-700-VITA(8482)

OR
fill the Secure Form below

(For orders inside the U.S (Up to 5 items) add $3.95 for shipping & handling)
(California residents add 8.25% tax)

DermaZinc Pump Spray
(How many?)

DermaZinc Shampoo			DermaZinc Soap
(How many?)			(How many?)

DermaZinc Cream 4 oz
(How many?)

PRESCRIPTION STRENGTH
DERMAZINC-PLUS
Dermazinc Spray 4oz
&
Clobetasol Propionate
(0.05%)

01 - $44.95 Each
02 - $41.35 Each
03 - $40.01 Each
04 - $37.31 Each

How
many?

Click here to print the Prescription
Form for Dermazinc-Plus

If you live outside of the United States click here .

We ship all our products World Wide and the Shipping costs will depend
on the weight of your package. If you would like to know the costs before
we mail it to you, fill and submit the form below only with your name,
complete address, Email and the number of units you would like to buy.
After you submit the Form, send us an Email: Contact@Sanavita.com

(Orders outside USA payable by Credit Card or money order only!)

Personal Details:

Diagnosis :
Name :
Street Address :

City:	State: Zip:
Country:
Day Phone:
Home Phone:
Email:

Methods Of Payment :

Credit Card :
	Mastercard Visa
	Credit Card Number :
	Exp. date: Month Year

Check By Mail or
Money Order :

Mail check or Money order payable to Sanavita Enterprises
3932 Wilshire Blvd. Suite 304
Los Angeles CA 90010

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E-Mail us at sanavita@mail.serve.com

Copyrights and Design by Rod Trindade
Email Rod Trindade@sanavita.com
Last Updated: November 2000