Checkout @ Canadian Pharmacy Online

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New customer?

If you have ordered with us before, please fill in the email address used for the first order and the last 4 digits of the credit card number for your personal information to be filled automatically.

Email:

Order ID or Last 4 digits of CC:

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Alternative phone no.:

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Important! You will receive an order confirmation to this address.

Shipping address

My Shipping Info

First & Last Name:

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Payment info

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Please note: commission will be charged for using PayPal

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This transaction will appear on your credit card statement as “”

Date of Birth:

( MM / DD / YYYY )

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Card Number:

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What is CVV2?

What is wire?

Holder Name:

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What is EuroDebit?

Routing Number:

Account Number:

ID Card Number:

Only for bank accounts in Germany!

What is ACH?

Routing Number:

Account Number:

Check Number:

The service charge of $1.95 will be added to the total sum of the check.

If you pay by e-check we will ship your order only after the payment is received which is approx. 5 business days after placing the order.

Corporate or Business Checks not accepted

What is BITCOIN

0.002367408 BTC

Fill in the form and click 'Submit Transaction' button
to receive BTC purse number.

Order # has been processed successfully.

Please send 0.002367408 BTC to

The QR code make it easy to pay from a wallet app on your smartphone.
Simply scan the QR code and it will pre-fill the BTC address/payment amount.

ATTENTION! Your order will be shipped only after you complete the payment.

USDT network:

199.95 USDT

Fill in the form and click "Pay with USDT" button to receive USDT wallet address.

Please make sure that the selected network is the same as the network of the platform you are withdrawing funds from or depositing funds to. If you select the wrong network, you can lose your funds.

As soon as you place the order you will get a USDT Address where you should send the specified USDT amount.

Order # has been processed successfully.

Please send 199.95 USDT to

The QR code make it easy to pay from a wallet app on your smartphone.
Simply scan the QR code and it will pre-fill the USDT address/payment amount.

ATTENTION! Your order will be shipped only after you complete the payment.

Submit Transaction

USDC network:

199.95 USDC

Fill in the form and click "Pay with USDC" button to receive USDC wallet address.

Please make sure that the selected network is the same as the network of the platform you are withdrawing funds from or depositing funds to. If you select the wrong network, you can lose your funds.

As soon as you place the order you will get a USDC Address where you should send the specified USDC amount.

Order # has been processed successfully.

Please send 199.95 USDC to

The QR code make it easy to pay from a wallet app on your smartphone.
Simply scan the QR code and it will pre-fill the USDC address/payment amount.

ATTENTION! Your order will be shipped only after you complete the payment.

Submit Transaction

2.172 LTC

Fill in the form and click "Pay with LTC" button to receive LTC wallet address.

Order # has been processed successfully.

Please send 2.172 LTC to

The QR code make it easy to pay from a wallet app on your smartphone.
Simply scan the QR code and it will pre-fill the LTC address/payment amount.

ATTENTION! Your order will be shipped only after you complete the payment.

Pay with LTC

1152.103 DOGE

Fill in the form and click "Pay with DOGE" button to receive DOGE wallet address.

Order # has been processed successfully.

Please send 1152.103 DOGE to

The QR code make it easy to pay from a wallet app on your smartphone.
Simply scan the QR code and it will pre-fill the DOGE address/payment amount.

ATTENTION! Your order will be shipped only after you complete the payment.

Pay with DOGE

0.104115 ETH

Fill in the form and click "Pay with ETH" button to receive ETH wallet address.

Order # has been processed successfully.

Please send 0.104115 ETH to

The QR code make it easy to pay from a wallet app on your smartphone.
Simply scan the QR code and it will pre-fill the ETH address/payment amount.

ATTENTION! Your order will be shipped only after you complete the payment.

Pay with ETH

Worldline is a world leader in bank processing systems. Now iDEAL and Google Pay are in.

Pay with Worldline

What is Western Union?

As soon as you place your order you should send us the payment. You will receive the instructions after you click on "submit transaction" button.

What is MoneyGram?

As soon as you place your order you should send us the payment. You will receive the instructions after you click on "submit transaction" button.

		Standard airmail service, 14-21 days	Free
		Trackable service, 5-9 days	30.00

Your Gender:	Male Female
Your Weight and Height:	( lb / in kg / cm )
Please list any current medical conditions:	None
Please list any prescription, herbal or over the counter medications you are currently taking:	I do not take any other medications
Please list any prescription, herbal or over the counter medications you plan to take while on this program:	I do not plan to take any other medications
Please list all allergies (including medications):	I do not have any allergies
Is there anything else in your medical history you deem relevant:	None
Do you have any of the following conditions: Leukemia, Multiple Myeloma, Sickle Cell Disease, Peptic Ulcers, or Retinitis pigmentosa?	No Yes
Do you take any form of nitroglycerine?	No Yes
We require a valid prescription for your order. Please fax or email it to /	I understand that if a prescription has not been provided, my order will not be processed

Your order

Billing address

Shipping address

Payment info

Refill reminder options

Medical Questionnaire


		Restasis®, 0.05% 0.4ml × 30 ^?Cyclosporine		199.95