Order Form for N.Z. Guaifenesin                     Australian Orders
Please fax to Jacqui at 649 264 1214                                   Any queries - ph Jacqui at 649 264 1213
Or post to Jacqui at P.O.Box 76-455, Manukau, Auckland 2241, N.Z.
If using post, you may fax or email   jacqui@voxau.com that your order is on it's way.              make a large cross
                                                                                                                                                                         against your choice
A.   I require 300 capsules x 300mg Guai @ $NZ 84.00 (less NZ GST) plus freight                A. _ _ _ _
                                                                                                                  ($NZ 28.00 per 100)
B.   I require 500 capsules x 300mg Guai @ $NZ 140.00 (less NZ GST) plus freight               B. _ _ _ _
                                                                                                                ($NZ 28.00 per 100)
C.   I require 300 capsules x 600mg Guai @ $NZ 126.00 (less NZ GST) plus freight               C. _ _ _ _
                                                                                                                ($NZ 42.00 per 100)
D.   I require 500 capsules x 600mg Guai @ $NZ 210.00 (less NZ GST) plus freight               D. _ _ _ _
                                                                                                                ($NZ 42.00 per 100)
E.   I wish to use Airmail to Australia at $NZ 15.00 per parcel                                       E. _ _ _ _
                        N.B. Parcels are sent Airmail if you do not state your choice.
OR   F.   I wish to use FedEx courier at approx. $NZ 60.00 per parcel to Australia         F. _ _ _ _

Payment details

My credit card         VISA / MasterCard (please circle one)                             Amount   $NZ _ _ _ _ - _ _

Clinic (if applicable)         _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Med No. _ _ _ _ _ _ _

 

FURTHER NOTES   (p2.)
 
Your doctor's prescription is necessary for both our Pharmacy and Customs purposes and we are then able to issue repeat orders to the max of 1,000caps x 300mg or 500caps x 600mg with the original scrip if it has followed our template.
Please note: Although we will do our utmost to help you, we cannot accept any liability for orders held up by Customs or lost in the country of delivery.

There are three ways you may handle your order:

• In all cases, we suggest you save this file to your hard drive.
  Take a copy to fill out for this order.
   
• 1. If you are happy with online security, you may then close the file and attach to an email.
        With an acompanying scrip, this is the easiest and fastest way to handle an order.
        Send to jacqui@voxau.com (omit signature in emails)
   
• 2. Or you may then print out your order including your credit card details
        and fax it through to Jacqui at +64 9 264 1214 with a copy of your scrip.
   
• 3. Or you may then print out your order including your credit card details
        and send it and scrip by snail mail to:
        Jacqui at Positive Living, P.O. Box 76-455, Manukau, Auckland 2241, New Zealand.
        In this case it is wise to inform jacqui@voxau.com that an order is on it's way.
   
• In all cases, we ask that the scrip be sent by snail mail please, to
        Jacqui at Positive Living, P.O. Box 76-455, Manukau, Auckland 2241, New Zealand.
  We are able to issue repeat orders to the max. of 1,000caps x 300mg or 500 caps x 600mg
  if we have the original scrip. We must have the original to protect our pharmacist
  and to have a doctor's authority if there are any problems with your Customs. Thank you.