Royal Alternative Medicine

Order

Supplement Order Form

Enter your full name
Shipping Address *
Shipping Address
City
State/Province
Zip/Postal
Do you have different billing address? *
Billing Address *
Billing Address
City
State/Province
Zip/Postal
Product *
Total

Credit Card Authorization Form
Credit Card Type *
This is the number from the back of your card.
Draw your E-Signature.

By signing this form, you give us permission to keep the above credit card on file and charge it for future orders. The card on file can be changed prior to your next transaction.

You are authorizing Royal Alternative Medicine LLC to charge and sign your card for future transactions using SQUARE.

*Royal Alternative Medicine LLC reserves the right to have NO RETURN and NO REFUND policy.