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Refill
Order Form
| This form is for existing customers
only. New customers please use this form instead. All information obtained
through this form is protected for your privacy and never shared
or sold to outside associates or third parties. |
Customer ID number: Leave blank if you do not know.
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Contact Information:
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Shipping Info: $9.99 Flat
Rate Air Mail - Free shipping on orders over $99.00
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Please update any changes
to your medical profile:
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List any changes with any drug
allergies. |
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Any additional medical history we need to be
aware of? Please explain here. |
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Medication(s) you would
like to refill:
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Please note that if a generic is unavailable, we will
contact you regarding possible brand name substitutions. |
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Billing Information: Visa
or Mastercard
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| The CVV code helps ascertain that the customer
placing the order actually possesses the credit/debit card and
that the card account is legitimate. Each credit card company
has its own name for the CVV code, but it functions the same
for all major card types. (VISA refers to the code as CVV2, MasterCard
calls it CVC2, and American Express calls it CID.) |
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Comments or Questions:
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Thank You For Your Order
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| Site Use
Policy: By using this site you
agree to the terms and policies between you and World Canadian Pharmacy. This
agreement also governs the use of our website worldcanadianpharmacy.com
and all of its contents. You agree to be bound by this agreement
each and every time you use this website and accept all responsibility
for all charges if any associated with connecting to World Canadian
Pharmacy prescription service. All prescriptions are filled by
World Canadian Pharmacy's fully licensed pharmacy and safety
sealed to ensure you the best quality. If you in any way disagree
with any content on this site or the terms and policies of World
Canadian Pharmacy, then you should discontinue use of this site
immediately. For Pharmacy information, please contact
us here. All RX customers must provide
us with a valid prescription before we can fill and ship any
prescription medications. |
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