(800) 929-8935

Mail payment to:
BioNeurix Order Dept.
5757 W. Century Blvd.
Suite 700
Los Angeles, CA 90045

(write e-mail address and date of order on check)

Order by Mail with Check or Money Order

In addition to ordering online with a credit card, you can also order AMORYN by mail with a check or money order. For your convenience and to reduce errors, you do not need to fill out and mail a paper order form by hand! Rather, you simply "order" by submitting the order information online using the form below. Then just mail us your payment, and once it's received we'll ship your order immediately. (Please allow about two weeks for delivery.)

To pay by mail you must submit your order online using the form below. Handwritten order requests sent by mail will NOT be accepted.

To order and pay by mail with a check or money order:
  1. Fill out the form below with your order information
  2. Click the 'Submit Order' button to send us your order request
  3. Mail payment (check or money order) to the address at left
  4. Once payment is received, your order will be shipped

You must write your e-mail address and order date on the check or money order.

You will receive an e-mail "receipt" to confirm that your order information was submitted successfully. Once we receive your payment and ship your order, you'll receive a second confirmation e-mail with a tracking number. Please contact us if you have any questions.

Name


Your E-Mail

Providing an e-mail address is strongly recommended,
but it's not required if you do not have one.

Select Product and Quantity


Select Shipping Method


Ship-To Address
Full Name:
Address:
City:
State:
Zip Code:
Country:

Daytime Phone (of ship-to recipient)


Evening Phone (of ship-to recipient)


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