OxyCare Client Sales Order Form

OxyCare Client Sales Order Form

(Physical Address Delivery)
Your Independent OxyCare Agent

Anton Coetsee

(Cell: 078 456 4787)
Date*

DayMonthYear
Customer/Account Information
Contact Name*

First NameLast Name
Phone Number*
Cell Phone Number
Email Address*
example@example.com
Delivery Address (Physical Address)*

Street Address

Street Address Line 2

CityProvince

Postal Code

Our Banking details are:

Mrs. C Coetsee

Capitec Bank

Savings Account

Acc. Nr. 154 689 2778

ORDER INFORMATION
OxyCare Product List*
prevnext( X )
OxyCare Drops
10ml Bottle (1 x Month's Supply)

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyCare Eye Drops
20ml Dropper Bottle

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyCare Nasal Spray
30ml Nasal Spray Bottle

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyCare Spray
100ml Spray Bottle

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyCare Cramp Medicine
500ml Bottle

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyCare Cream
100ml Container

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyVita
30 Capsules

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyPain
30 Capsules

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxySkin
30 Capsules

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyMoringa
30 Capsules

160.00ZAR Quantity
Item subtotal:0.00ZAR



OxyHair
100ml Spray Bottle

160.00ZAR Quantity
Item subtotal:0.00ZAR



Courier Guy Courier Cost 1
UP TO 20 PRODUCTS OR 2KG

Courier Guy cost of R90 applies for orders from Clients to a Physical Address.

5 to 7 working days delivery period.

90.00ZAR



Courier Guy Courier Cost 2
21 T0 30 PRODUCTS OR 3KG

Courier Guy cost of R100 applies for orders from Clients to a Physical Address.

5 to 7 working days delivery period.

100.00ZAR



Courier Guy Courier Cost 3
21 T0 30 PRODUCTS OR 3KG

Courier Guy cost of R110 applies for orders from Clients to a Physical Address.

5 to 7 working days delivery period.

110.00ZAR



Total

0.00ZAR
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