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Name
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First
Last
Area Code and Phone Number
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How Would You Like To Receive Your Order
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Pick Up In-Store
Curbside
U.S. Postal Mail
If You'd Like Your Order Mailed, Enter Your Street Address, Apt or Suite #, City, State and Zip Code Below
Preferred Payment Method
*
Cash (For Store Pick-Up Only)
Check
Credit/Debit Card
We Will Take Your Specific Payment Info Over The Phone
Item #1 Order Details
Include Item Name, Size or Pill Count, How Many Containers of Item
Item #2 Order Details
Include Item Name, Size or Pill Count, How Many Containers of Item
Item #3 Order Details
Include Item Name, Size or Pill Count, How Many Containers of Item
Item #4 Order Details
Include Item Name, Size or Pill Count, How Many Containers of Item
Additional Items, Questions, Info Enter It Below
Best Time For Us To Call You
10 am to Noon
Noon to 2 pm
2 pm to 4pm
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