Hypavera Mail In Order Form

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Call us with Questions 877.633.2671

• Print out this Form: Fill in and Mail order form along with your check or money order.

Make Checks or Money Orders Payable to:

MedcoSouth Healthcare

Mail to:
MedcoSouth
P.O. Box 886
Lebanon, TN 37088

	Please select
__________	Hypavera™ Single Bottle $67
__________	Hypavera™ Buy 2 Get 1 Free $127
__________	Hypavera™ Buy 3 Get 3 Free $187
	Shipping
_$0___	Priority Mail Free
	Total
__________	Product Price + Shipping Fee

Your Information

First Name ___________________________ Last Name _______________________________

Shipping Address_______________________________________________________________

City ______________________________ State _____________ Zip______________________

Telephone (__________) ________________________________

Email________________________________________________
MUST HAVE VALID CONTACT INFORMATION AND PHONE NUMBER

• All checks are held for 10 business days. Orders placed with a check will be held for 10 business days. Once 10 business days is complete, the order will be released and shipped.
• All returned check will be charged a $25 USD return check fee.
• Counter checks will not be accepted.
• Check orders without phone number will not be processed.