FAX / MAIL ORDER FORM

  
1. Print This Form by going to "File" in your browser than select print.
2. Complete than fax to 1- (801) 650-6817, or mail to: Nova, Co., 564 Oakland Ave. Suite 6, Oakland CA 94611 USA you will receive confirmation via e-mail.
Bill to Information (please print clearly)
Full Name:  
Street Address:
City: Phone (optional):
State: E-mail(please verify):
Postal Zip: Country

Payment by (check one): [_]Visa [_] MasterCard [_] Personal Check [_] MoneyOrder
Credit Card # : Signature:
Expiration Date: Date:
Shipping Information if same as above check here [ ]
Name: Address:
City:
State:
Postal Zip:
*Complete therapy includes two O2 plus (2oz.) And one DMSO Rose Cream (4oz.)
Item
Price
Quantity
Total
*Complete Therapy
$49.95
    
Colon8
$19.95
    
O2 Plus™ (2oz.)
$19.95
    
DMSO Rose Cream (4oz.)
$19.95
    
(California residents only) Sales Tax add 8.25%
 

Shipping Flat rate Priority Domestic ($5.85)

Shipping Flat rate Air Mail International ($12.95)

 
------------Grand Total---------
  
Comments or special instructions