LOADING...  Please wait.

Product Order Form
Lux Health Resources
5233 Joyce St., #1104
Vancouver, British Columbia V5R 4G9
CANADA
 
1. T Cell TherapyPeptide & B7 Herbs  
Cost by Weight:
Q
 T
2. Nerve GrowthNeuron Factors  
 
Cost by Weight
Q
 T
3. CancerThunder God Vine & Chemo Herbal 
Cost by Weight
Q
 T
4. HIV/AidsPKC ActiveBET InhibitorImmune Fix
Cost by Weight
Q
 T
5. Deaf/Hearing lossNotch Inhibitor  
Cost by Weight
Q
 T
Subtotal
Tax (BC 5.00%):
Shipping & Handling:
Grand Total:
Customer E-Mail
E-Mail:*

Patient`s Weight in lbs*

Patient`s age*

Condition/Diagnosis*

Billing Information
First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Phone:

City:*

State:-U.S.A.

State/Province

Zip or Postal Code:*

Country*

Shipping Information
Same as billing information?
Yes No 

First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Phone:

City:*

State:*

Zip Code:*

Payment Information
Payment Method:*
Credit Card Other 

Card Number:*

Expiration Month:*

Expiration Year:*

CVV:*

Card Brand:*

Alternative payment

eTransfer-contact us
Reset