Neuropathal Order Form


ORDER WITH CONFIDENCE

We understand that security is a major concern when ordering online.
We want you to know that our order pages utilize high levels of security protection.
Once your credit card numbers are entered into the order page, they are encrypted
and are not visible to anyone inside or outside of our company.

First Name: *
Last Name: *
E-mail: *
Street Address 1 *
Street Address 2
City *
State *
Postal Code *
Country
Leave blank if same as above
Street Address 1
Street Address 2
City
State
Postal Code
Country
Card Type *
Card Number *
Expiration Month *
Expiration Year *
CVC *
Neuropathal 2oz: Sample Size
1 Payment of $0.00
$0.00
Subscription Purchase
4oz Supply – Billed Monthly at $37 + S&H
Total Amount You Pay Right Now

Process
I have read and understand the terms of this agreement.
(Enter your initials)
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* Terms of this Agreement – We will ship you a fresh 1 month supply after
your 14 day free trial;expires.Your supply of Neuropathal will be refreshed every 30 days
for $37.00 plus $6.97 for shipping and handling.
Of course you can cancel or customize your order any time by calling customer
service at 888-840-7142 or
emailing us at
billing@neuropathytreatmentgroup.com.



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