Order by Toll Free fax
866-343-7716

Drugstoreone.com

 
To order medication, please print this form.
Fill it out and fax it to us at the toll free # 1-402-488-5171
* Denotes a Required field. These fields need to be filled in for us to process your order.
Order by Fax
Form No: Date:
Billing Address
Name: ______________________ ______________________
 
First Name
Last Name
Address:  
City:   State/County:  
Zip Code:   Country:  
Contact No.:   Email ID:  
Shipping Address (Mention whether same as Above)
Shipping Address
(*If your Shipping Address is different from you billing Address please fill it in below)
Address:      
City:   State/County:  
Zip Code:   Country:  
Contact No.:      
Payment Details
(All credit card information is processed via Secure Servers and is protected with maximum security).
Credit Cards:
(Please Circle the Credit Card that you want to use)

MasterCard

Visa
American Express

Diners Club International

JCB Cards
Citibank eCards
Credit Card No:   Expiry Date:  
Signature on Card:      

Drug Name & Strength Quantity Requested
Example Drug 100 mg 90 pills
1)  
2)  
3)  
4)  
5)  
   
   
   

Drugstoreone Top Products
[
Prices Indicated In USD per Tablet/Capsule ]
Allegra 180 mg (Fexofenadine)
2.00
Norvasc 10 mg (Amlodipine)
0.40
Amaryl  3 mg (Glimepiride)
0.45
Ovral 0.5 mg (Norgestrel)
0.69
Amoxil 250 mg (Amoxicillin)
0.35
Paxil 20 mg (Paroxetine)
0.80
Antabuse 500 mg (Disulfiram)
1.50
Pravachol 20 mg (Pravastatin)
0.95
Celebrex 200 mg (Celecoxib)
0.85
Prevacid 15 mg (Lansoprazole)
0.45
Celexa 20 mg (Citalopram)
0.49
Prilosec 20 mg (Omeprazole)
0.45
Tadalafil 20 mg (Tadalafil)
3.00
Propecia 1 mg (Finasteride)
0.70
Cipro 500 mg (Ciprofloxacin)
2.25
Prozac 20 mg (Fluoxetine)
0.42
Clomid 50 mg (Clomifene)
0.99
Singulair 10 mg (Montelukast)
1.10
Diflucan 150 mg (Fluconazole)
4.00
Soma 350 mg (Carisoprodol)
0.45
Doxycycline 100 mg (Doxycycline)
0.43
Sporanox 100 mg (Itraconazole)
1.70
Evista 60 mg (Raloxifene)
0.85
Synthroid 100 mcg (Levothyroxin)
0.18
Flagyl 400 mg (Metronidazole)
0.89
Tenormin 50 mg (Atenolol)
0.33
Fosamax 70 mg (Alendronate)
5.90
Topamax 100 mg (Topiramate)
1.28
Glucophage 500 mg (Metformin)
0.30
Toprol XL 50 mg (Metoprolol)
0.50
Glucatrol XL 5 mg (Glipizide)
0.25
Ultram 50 mg (Tramadol)
0.75
Lamisil 250 mg (Terbinafine)
4.00
Sildenafil Citrate 100 mg (Sildenafil Citrate)
2.50
Lasix 40 mg (Frusemide)
0.15
Wellbutrin SR 150 mg (Bupropion)
0.90
Hydrochlorothiazide 25 mg (HCTZ)
0.15
Zanaflex 2 mg ( Tizanidin)
0.65
Imitrex 100 mg (Sumatriptan)
4.25
Zithromax 250 mg (Azithromycin)
1.50
Lamisil 250 mg (Terbinafine)
2.00
Zocor 20 mg (Simvastatin)
1.45
Lipitor 20 (Atorvastatin)
0.90
Zoloft 100 mg (Sertraline)
0.95
Nexium 40 mg (Esomeprazole)
0.60
Zyban SR 150 mg (Bupropion SR)
1.65
    Zyrtec 10 mg (Cetirizine)
0.85

[Prices listed here are subject to change]