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: NO INTERNATIONAL CHECKS OR MONEY ORDERS ACCEPTED

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
_$5.95 or $29.95___

$5.95 Priority Mail in USA___ Note:$29.95 International Shipping

  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.