Stanfin Pharmacy
 

 

 

 

 

Order Form:

Full Clinic Service

Specials

  Terms and Conditions

To order our products online for delivery in Standerton South Africa only  just complete the form below:

Payment method cash on delivery

 To print this form, click on the page and select Print Option

  Complete the Order Form:


Full Name: E-mail:
PO Box: Cell Phone:
Street Address:
City / Town: Code:
Home Phone: Work Phone:

Please calculate the total of your order and type the total amount of your order in line 16 before you click on the submit button.

  Description Quantity Price per Item Total per Item
1. R R
2. R R
3. R R
4. R R
5. R R
6. R R
7. R R
8. R R
9. R R
10. R R
11. R R
12. R R
13. R R
14.  

 

R R
15.  

 

R R
16 TOTAL OF ORDER

 

TOTAL: R

Please calculate the total of your order and type the total amount of your order in line 16 before you click on the submit button.

PAYMENT METHOD CASH ON DELIVERY ONLY:

Please type the amount of change needed in the block space below:

(example for R50, R100 or R200)

Change needed for:

Please print your Order form for your own record.

Please ensure that all Information are provided before you click on the Submit button!!!

 



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