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Therabreath Wholesale Order Form

Quantity Product Format
TEST PACK : 6 Oral Rinses (500 ml), 6 Toothgels (toothpaste 118g) and 6 Tonguescleaners  
Oral Rinse  500 ml x 25
ToothPaste (gel) Fluoride & Aloe Vera  118g x 12
Breath Spray  60 ml x 24
Power Drops  15ml x 24 
Oxygenating Chewing Gum  100 p/bottle x 24
Oxygenating Chewing Gum 17 pcs  17 pcs x 24
Saliva Stimulation Tablets sheet 30 lozenges  30 tablets x 24
Tongue Cleaner  1 pce. x 24
Toothbrush     1pce x 24
TheraFresh Toothbrush Spray   30 ml x 24

 

 

 

 

1. Billing information: you will receive a confirmation and pro forma invoice before your payment will be processed.

    Pay by Creditcard:

 

  • Creditcard number:         
  • Expiration date:               
  • Cardholder name:            

 

No creditcard? That’s OK, there are other ways to pay  click here

2. Type of shipping

Regular Shipping

Express Mail Ground

EMS



3. Shipping adress

* If you ordered before, just fill in NAME, COUNTRY AND POSTAL CODE

 

  Company or last Name *
  Attention:
  Delivery Street adres 
  Delivery Postal Code *
  Delivery City
  Country *
  Email adres
  V.A.T. number
  Phone eg. 09 / 2811835
  Fax eg. 09 / 2811492
Did you order before?   *
No
Yes
* If you ordered before, just fill in NAME, COUNTRY AND POSTAL CODE
 
4. Do you want to send a question or message:

                      


Thank you for ordering. We will first send you a confirmation.
You can also order by phone, fax or mail:
  • By Post: Therabreath, PB 1, B9830 St MARTENS LATEM, BELGIUM
    •  
  • By Fax: + 32 9 281 1492
    •  
  • By Phone: + 32 9 281 1834


We are looking for distributors all over Europe. If you are interested and you do live in any of the European countries (except for the UK & Ireland), please click here

Copyright 2002, Dr. Harold Katz & Fresh Start LLC. All international rights reserved.