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Simply
Print And Mail With Payment To:
CyberMed Industries
1039 View Street, #1010
Victoria, B.C.
v8v4v6 Canada
Please
make checks/money orders payable to "CyberMed
Industries "
Company Name (if applicable):
Contact Person:
Phone Number:
Fax Number:
E-mail Address:
Delivery/Mail Address
(Address, Zip etc):
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Below
please enter Cardholder's Address exactly
as shown on Credit Card statement!
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Cardholder's Name as on card:
CC# Street Address:
CC# City:
CC# Country:
CC# State:
CC# Zip/Country Code:
You
will get results within the first month but
it takes 3 to 4 months for optimum results.
We never automatically ship more bottles to
you and bill your credit card unless you re-order.
 Canada
- Any size order add $5.00
 United
States - Any size order $10.00
 International
orders -Any size order, Air Only- $15.00
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