Resperin Order Form: United States
Just fill in the required information, print and mail or fax.
Mail to: Resperin™ Canada Ltd.
420 Erb St. W. Suite 5-209
Waterloo, Ontario, Canada, N2L 6K6
Fax: 1 (519) 725 4864
Name:
Email:
Address:
City: State:
Zip: Phone:
Product Request: 1 Bottle Resperin's Caisse Formula Tea - $65.00 2 Bottles Resperin's Caisse Formula Tea - $130.00 3 Bottles Resperin's Caisse Formula Tea - $195.00 4 Bottles Resperin's Caisse Formula Tea - $260.00 5 Bottles Resperin's Caisse Formula Tea - $325.00
(All orders are processed in US funds)
Payment Method: Cash Visa Master Card Money Order
If paying with Visa or Master card, fill in the following additional information.
Card # Expiration: mm yy
After printing this page, click here to return to the order page, or visit our home page.