This area allows you to securely make a credit card payment on-line
in any amount for your purchase from Symbiotic Systems, Inc.

Symbiotic Systems, Inc.

Secure Server On-line Order Form

 

Sorry folks, but we are no longer selling Lice Rx due to corportate greed. Since the corporations couldn't patent our product, they had your government make it illegal so, enjoy head lice America. After 15 years we can no longer help you. Sorry.


We accept Visa, Mastercard,
American Express and Discover cards.

Your transaction will be 100% secure. All information provided will pass through our RSA Approved SECURED SERVER. To pay on-line right now using our 100% secured server, simply fill in the following sections of this form. Use the tab to move from field to field until you reach the multi-selections and then click on the box to highlight your choice. Your e-mail address is important so that we can send you a confirmation of shipping.


Order Yours Today!

Name
Company Name
Shipping address
City
State
ZIP or Postal Code
Country
Phone Number
Fax Number
E-mail Address
Please pick your choice
Need a lice comb?
US$ Enter sub-total of products here
US$ Add 5 % for Idaho Residents here
Click here to add Shipping charges
US$ Add sub-total, tax (if any) and shipping here. Total Amount Due.
Pls tell us-- How did you hear about Lice Rx?
Locally, how bad is the infestation?
Additional comments/Special requests:

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Thank You For Your Order! We know you'll be pleased.






Thank you for your order.


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1997/8/9/2000/2001/2002/2003 Symbiotic Systems, Inc.
Most recent revision Wednesday, October 8, 2003