Lice RX
Costs And Ordering Information

Please fill out the form below and send it to us so we know to watch for your payment. Then mail your check to the address below today. When your payment arrives, we'll match it up with this form and ship your order out. We'll advise you by e-mail that your order has been shipped so you know to watch for it.

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Please mail your payment to:

Symbiotic Systems, Inc.
P.O. Box 2056
Hailey, ID 83333-2056

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Online Order Form When Mailing Your Payment

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Just fill out the simple form below. Use the tab to move from field to field until you reach the multi-selections and then click on the button to view & select your choices.

Your e-mail address is important so that we can send you a confirmation of shipping or advise you of any problems processing your order. If you do not include a valid e-mail address, you will not hear from us and your order will go unfilled until you contact us again. Please check and double check everything especially your e-mail address.
Note: AOL users, your e-mail address ends in ".aol.com".
We can't respond without it.

 

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Name
Company Name
Shipping address
City
State
ZIP or Postal Code
Country
Phone Number
Fax Number
E-mail Address
Please pick your choice
Need a lice comb?
US$ Enter sub-total of products here
US$ Add 5 % for Idaho Residents here
Click here to add Shipping charges
US$ Add sub-total, tax (if any) and shipping here. Total Amount Due.
Pls tell us-- How did you hear about Lice RX?
Locally, how bad is the infestation?
Additional comments/Special requests:

Very important -- Double Check Your E-mail Address and All Numbers
Before Pressing Submit. Typos are the cause of most delays.
(Please press only once. It might take a moment.)

Thank You For Your Order! We know you'll be pleased.

There is a $10.00 fee for any check returned for any reason. Placing your order, you agree to this stipulation.



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1996/7/8/9/2000/2001/2002/2003 Symbiotic Systems, Inc.
Most recent revision Wednesday, October 8, 2003