Orderform Dr. Rath Health Programs - Combinations – EN

Page 1

ORDERF O R M

COMBINED SYNERGIES DR. RATH CELLULAR MEDICINE™ FORMULAS

I am already a customer, my customer number is:

Qyt.

EN

Please tick this box if you fax your order again due to an error message. Order fax: +31 (0)45 71 11 119 Postbus 657 NL – 6400 AR Heerlen Email: info@rath-programs.com IBAN: NL80.ABNA.0505.4511.82 BIC: ABNANL2A

Free Call from UK: 0808-10 11 555* Order hotline: +31 (0)45 71 11 112 Monday – Friday: 08:30 am – 05:00 pm CET Online-Shop: https://www.dr-rath.com

I am a new customer, the ID of my consultant (if known) is:

* Free for landline calls from the United Kingdom (England, Scotland, Wales and Northern Ireland). Charges from mobile phones may vary.

On the recommendation of: Name:

Art. no. Product

Price €

COMBINED SYNERGIES 2200 Synergy Combination EpiQuercican™ 3x Vitacor Plus™ [90 capsules]; 3x EpiQuercican™ [180 capsules]

273.90

2201 Synergy Combination Arteriforte™ 3x Vitacor Plus™ [90 capsules]; 3x Arteriforte™ [60 capsules]

257.90

2202 Synergy Combination Osteoforte™ 3x Vitacor Plus™ [90 capsules]; 3x Osteoforte™ [120 capsules]

240.90

2203 Synergy Combination Diacor™ 3x Vitacor Plus™ [90 capsules]; 3x Diacor™ [90 capsules]

257.90

2204 Synergy Combination Dr. Rath Phyto ProM™ 3x Vitacor Plus™ [90 capsules]; 3x Dr. Rath Phyto ProM™ [120 capsules]

260.90

2205 Synergy Combination Enercor™ 3x Vitacor Plus™ [90 capsules]; 3x Enercor™ [60 capsules]

257.90

2206 Synergy Combination Relavit™ 3x Vitacor Plus™ [90 capsules]; 3x Relavit™ [120 capsules]

260.90

2207 Synergy Combination Femicell™ 3x Vitacor Plus™ [90 capsules]; 3x Femicell™ [60 capsules]

224.90

2208 Synergy Combination ImmunoCell™ 3x Vitacor Plus™ [90 capsules]; 3x ImmunoCell™ [120 capsules]

237.90

2210

Synergy Combination EpiQuercican™ Intensive

449.90

3x Vitacor Plus™ [90 cap.]; 3x EpiQuercican™ [180 cap.]; 3x LyCin™ [420 gr. powder]; 3x Prolysin C™ [120 cap.]; 3x VitaCforte™ [120 cap.]

2211 Synergy Combination Metavit™ 3x Vitacor Plus™ [90 capsules]; 3x Metavit™ [90 capsules]

244.90

2212 Synergy Combination Lensivit™ 3x Vitacor Plus™ [90 capsules]; 3x Lensivit™ [60 capsules]

217.90

2213 Synergy Combination Illioforte™ 3x Vitacor Plus™ [90 capsules]; 3x Illioforte™ [90 capsules]

207.90

2220 V-Defense Combination 1x Vitacor Plus™ [90 capsules]; 1x YouCell™-V [60 capsules]; 1x Dr. Rath Vitamin D3™+K2 vegan [90 capsules]

99.90

10007 Diacor™ DRRI Combination 1x Diacor™ [90 capsules]; 1x Osteoforte™ [120 capsules]; 1x Dr. Rath Vitamin D3™+K2 vegan [90 capsules]

92.90

10049 YouCell™-IQ Brain Kickstarter Combination 1x YouCell™-IQ [30 capsules]; 1x Dr. Rath VitaC Go! [30 sticks] YouCell™-IQ Brain Master Combination 20049

44.90

1x YouCell™-IQ [30 capsules]; 1x VitaCforte™ [120 capsules]; 1x Dr. Rath Omega 3 Vegan™ [60 capsules]; 1x Dr. Rath Vitamin B Complex [90 capsules] Delivery costs

UK Ireland

3.20 € 12.90 €

Denmark Finland

5.90 € 12.90 €

Sweden Bulgaria

6.90 € 16.90 €

Slovenia Lithuania

12.90 € 12.90 €

Estonia 12.90 € Czech Republic 12.90 €

SENDER (Please use capital letters):

DELIVERY ADDRESS (if different):

Name:

Name:

Adress:

Adress:

Zip/Postal code:

Zip/Postal code:

Town: Country:

Town:

Telephone:

Country: –

Email address : *Please fill in to receive the latest health information.

Open account payment

SEPA Direct Debit Account holder:

METHOD OF PAYMENT

*

Please note that it will take 14 days to process your request after receiving the subscription! Vitamin subscriptions are free of charge. Please note: for every change in vitamin subscription there is a charge of 6.90 €. The products are sent at risk of the purchaser. Delivery is subjected to the Dutch regulations. I accept that the data concerning my credit card are registered in your database to allow the payment of my future orders. Moreover, I declare that the invoices of my next orders could be paid with this credit card, unless otherwise specified. www.dr-rath.com. Errors and omissions excepted (18/04/2023 English).

Place, date and signature (Please sign here for orders. Please also note the signature line in the payment methods).

SEPA mandate already exists Bank:

IBAN: SWIFT code (BIC):

I/We hereby authorise Dr. Rath Health Programs to withdraw payments from my/our account by way of direct debit transactions. At the same time, I/we instruct my/our bank to cash direct debit transactions that are drawn from my/our account by Dr. Rath Health Programs B.V. NB: I/we may request a refund of the debited amount within eight weeks of the debit date. The terms and conditions agreed with my/our credit institute shall apply.

99.90

Latvia 12.90 € Other countries: on request

Total price per delivery

DOB:

#1445/01-121023EN

Attention: Duplicate faxes!

Place, date and signature


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