Diabetes Order Form

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Diabetes Order Form

ENSURE YOU READ AND UNDERSTAND THE CONTEXT INCLUDING THE COST BEFORE YOU FILL THE FORM

DO NOT FILL FORM AS LONG AS YOU'RE NOT SURE OF YOUR FINANCIAL CAPABILITY AND AVAILABILITY

FULL NAME: *

DELIVERY LOCATION: *

PHONE NUMBER *

WHATSAPP NUMBER *

CHOICE OF PACK NEEDED: *

5 BOTTLES (#85,500)

3 BOTTLES (#59,500)

2 BOTTLES (#44,500)

DELIVERY PERIOD (We Only Accept Delivery Period Within Below Time Specification) *

DELIVER TO ME AS SOON AS POSSIBLE

DELIVER TO ME TOMORROW

DELIVER TO ME NEXT TOMORROW

NOTE: Kindly be sure, financially ready and available before you submit this form. *

Yes. I've Understood and I Accept The Terms And Condition Without Disappointment.

Submit

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