Order Form

OPTIMOX
2300 South Main Street, South Salt Lake, UT 84115
Phone: 800 223-1601
www.optimox.com

 

CONSUMER ORDER FORM

 
IODORAL® OPTIVITE® PMT GYNOVITE® PLUS MAG-200 ATP COFACTORS ANDROVITE® FOR MEN
Product Prices Quantity

Total Cost

IODORAL®
90 tablets $28.98/bottle
   
IODORAL®
180 tablets $53.24/bottle
   
IODORAL® IOD-50
30 tablets $35.14/bottle
   
IODORAL® IOD-50
90 tablets $89.46/bottle
   
OPTIVITE® PMT
180 tablets $27.68/bottle
   
GYNOVITE® PLUS
180 tablets $27.68/bottle
   
MAG-200
120 tablets $15.96/bottle
   
ATP COFACTORS
90 tablets $26.62/bottle
   
ANDROVITE® FOR MEN
180 tablets $27.68/bottle
   
[ ] UPS [ ] UPS Next Day* [ ] UPS 3-Day*
[ ] USPS Mail** [ ] UPS 2nd-Day* [ ] COD $11.00
     
*Available for extra cost
**For PO boxes only

Please call for
correct sales tax.

 

COD

 
Shipping $7.50
TOTAL  
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