Order Nembutal Online

Order Form
Full Name*

First NameLast Name
Product*
Quantity*

Nembutal Oral Solution (Sterile 250ml)Nembutal Solution (Injectable) 250ml)Nembutal Oral Solution (Sterile 100ml)Nembutal Oral Solution (Sterile 100ml) x 2Nembutal Oral Solution (Sterile 100ml) x 3Nembutal Oral Solution (Sterile 100ml) x 4Nembutal Solution (Injectable) 100mlNembutal Solution (Injectable) 100ml x 2Nembutal Solution (Injectable) 100ml x 3Nembutal Solution (Injectable) 100ml x 4Nembutal Solution (Non-sterile 50ml)Nembutal Solution (Non-sterile 50ml) x 2Nembutal Powder 100gramsNembutal Powder 15gramsNembutal Powder 30gramsNembutal Powder 100gramsNembutal Test Kit
E-mail*
Mobile Number*

Area CodePhone Number
Preferred Contact Online*

SkypeE-mailPhone Number
Skype
Courier*
Complete Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
* Note: Bulk orders may directly send email to: info@vidatermino.com

(Please include the product #, Quantity, Color and Size in your email.)
Special Instructions & Requests*
Confirmation*

I am fully aware that I have read and agreed to abide the Terms and Conditions of Peaceful Exit
Anti Spam:*
Should be Empty:

Order Form