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CLARITIN® REFILL ORDER


Please take a few minutes to fill in the following information as thoroughly and accurately as possible. Please fill in all spaces completely. Spaces left blank will only delay your order. If a question does not apply to you please write in Not Applicable (NA). A signature is required for delivery; therefore, we are unable to ship to a P.O. Box.

Personal Information 

Please fill in all fields.  Failure to do so will delay your order processing. ALL must be completed to submit form

First Name
Middle Initial
Last name

Birthdate(mm/dd/yy)

Address

Apt#

City
State
Zip
Country
Phone
E-mail
Confirm E-mail
Sex Height Inches
Weight  

 

Your approved ClaritinŽ prescription entitles you to (3) refills over 6 months. Please check a box below to indicate your order.

Claritin 10 mg Tablets

  30 - 10mg Tablets $  67.50 + $18 Shipping= $  85.50
  60 - 10mg Tablets $135.00 + $18 Shipping= $153.00
  90 - 10mg Tablets $198.00 + $18 Shipping= $216.00
120 - 10mg Tablets $264.00 + $18 Shipping= $282.00

Claritin Reditabs

  30 - Reditabs $  88.50 + $18 Shipping = $106.50
  60 - Reditabs $177.00 + $18 Shipping = $195.00
  90 - Reditabs $261.00 + $18 Shipping = $279.00
120 - Reditabs $342.00 + $18 Shipping = $360.00



International orders are $46 to ship. If you choose to ship your order outside the U.S., you are assuming all liability for any customs, duties or tariffs. If for some unforeseen reason your order is seized by Customs, we are unable to refund your money. By selecting International shipping, you are agreeing with these terms. Note: International orders please add an additional $28.00 to the above totals (difference between $46.00 - $18.00).






Credit card number

Expiration date
Billing city

Name as it appears on card

Billing address
zip code
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(Please enter address if different than above), Please be specific.


How did you hear about us?

  • I certify that I am 18 years of age or older.
  • I have read and agree to the Waiver of Liability.
  • I am legally allowed to receive prescription medication at my shipping address.
  • I understand all the side effects of ClaritinŽ.
  • I do not have a current prescription for ClaritinŽ from another physician.
  • I certify that I am allowed by law to use the credit card I have presented.
  • I understand that falsifying information in order to obtain prescription medication is a violation of both state and federal law.
  • I hereby certify that I have answered all questions truthfully.