TinnitusWars · Order Form
Subsidiary of SinusWars LLC

Please print out this form, fill it in and fax it to us at 1-302-358-2980 in the US

First Name:

Surname:

Shipping Address:

City:

State:

Zip Code:

Country:

Telephone:

Fax:

Email:

Please double check the email address. We need it to send a confirmation of the order.

Please supply me with the following TinnitusWars Remedies:
Please note that 1 unit consist of a six week supply and SinusWars #17 consist of a 12 week supply

Units

Remedy

Price per unit US$

Totals in US$

SinusWars 4 – Ear Infections

39.95

SinusWars 16 - Tinnitus

39.95

SinusWars 17(12 week supply) - Meniere's Disease

74.95

SinusWars 18 - Hyperacusis

39.95

SinusWars 19 - Vertigo

39.95

Please choose a shipping method
USA SHIPPING METHODS (Shipped from the US)

		Total
USPS PRIORITY MAIL Shipping delivery within 3-10 days	$5.00
UPS Ground Shipping delivery within 3-6 days	$7.00
UPS 3 day shipping delivery within 2-5 days	$12.50
UPS Second day shipping delivery is 2 Business Days	$22.00
UPS Next Day shipping is 1 business day.	$35.00

International (Worldwide) Shipping methods

USPS delivery within 7-21 days	$12.50
Remedies Total
Shipping Cost
Total $

Card Details

NAME ON CREDIT CARD:
CREDIT CARD TYPE:
CREDIT CARD NUMBER:
LAST 3 DIGITS OF NUMBER ON THE BACK OF YOUR CARD:
EXPIRATION DATE:	Month:	Year:
SIGNATURE:
DATE:
COMMENTS: