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ORDER FORM

Propecia

Please complete all of the following fields;
    PLEASE SEND ME;-

    *

ALL PRICES ARE IN U.K POUNDS STERLING (£)

Exchange rate? - >>CLICK HERE<<

The price includes;- your consultation fee !
OTHER CURRENCIES? -- orders will be applied to your credit card in U.K. Pounds, the amount will automatically be debited in your own currency, at the rate prevailing on the day of transaction by the credit card company.

Customer is responsible for all customs, tariffs, and taxes, if applicable to their country.

Standard medical practice requires your General Practitioner / Doctor to be aware of any medication prescribed to you.

    I take responsibility for informing my G.P. / Doctor * YES NO

    If you have selected "NO", you must enter your doctors name and address below, so that DRM can inform them

    Is there any reason why you believe you may not be able to take Propecia? * NO YES

    DRM advise you to discuss any concerns about this questionnaire or the use of Propecia with your own Doctor.

SIGNED *

    TITLE (Mr,Mrs, )

    FIRST NAME

    *

    FAMILY NAME

    *

    Date Of Birth.

    *

    EMAIL ADDRESS.

    *

    DESPATCH ADDRESS

    *

    *

    COUNTY / AREA

    *

    COUNTRY

    *

    ZIP/POST CODE

    *

    FAX NUMBER

    DAYTIME TEL NO

    *

    Please debit my credit card.
    *
    We accept Visa and Mastercard.
    Expiry date of card
    *
    Name (as it appears on card)
    *
    Please acknowledge;-

    I am aware that my order will be charged in £ (GB Pounds sterling) and the exchange rate will be determined on the day of transaction

    * YES

    Please enter any comments in this space.
    Please enter your name and email address here, so that we can acknowledge your order
    Name*

    Email*

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Read our Privacy Statement and Customer Guarantee

ALL PRICES ARE IN U.K POUNDS STERLING (£)

The price includes;- your consultation fee !
OTHER CURRENCIES? -- orders will be applied to your credit card in U.K. Pounds, the amount will automatically be debited in your own currency, at the rate prevailing on the day of transaction by the credit card company.

    Goods are despatched tax-free in the EU, but DRM cannot be responsible for local taxes or import restrictions which may apply in other countries.

    Your order will normally be despatched on the day of your order if received before 1P.M (not weekends or holidays). Orders to the UK should arrive within 48 hours. Please allow 7 working days to Europe, 15 working days to rest of the world.

    YOUR GUARANTEE! - If your goods do not arrive for any reason, DRM will re-ship or refund your order!


VIAGRA
XENICAL / ORLISTAT for weight loss
UPRIMA faster than Viagra
PROPECIA for hairloss


XENICAL is the trademark of F. Hoffmann-La Roche Ltd
Propecia is the trademark of Merck & Co., Inc.
Viagra is the registered trademark of Pfizer Inc. NY.
All other trademarks are acknowledged as being the property of their respective owners


General Enquiries - email: Email DRM

Order Enquiries - email: Email order dept


89.145.89.36