Resperin Order Form: International

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:              

Address:   

City:                    Province/State:   

Country:             Country Code:     

Phone:      

Product Request:    1 Bottle Resperin's Caisse Formula Tea $45.00 = (Total) $45.00 2 Bottles Resperin's Caisse Formula Tea $90.00 (Total) $90.00 3 Bottles Resperin's Caisse Formula Tea $135.00 = (Total) $135.00 4 Bottles Resperin's Caisse Formula Tea $180.00 = (Total) $180.00 5 Bottles Resperin's Caisse Formula Tea $225.00 = (Total) $225.00  

(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.