Fields marked by asterisk (*) are obligatory.
Shipping Address (if is different than above)
Please be informed that by sending this Order Form you accept the processing of your personal data necessary to accomplished this order only (in accordance to the Data Protection Act 1998 and relevant legislation (unified text: Journal of Laws of 2014, item 1182 with amendments). All data received are confidential. You have right to inspect, correct and erase your personal data.
Data for Payment (in €): Beneficiary: Phytomedica Polska, Bank Account No: PL 92 1240 1040 1978 0011 0052 3699 BIC (SWIFT Code): PKOPPLPW
Aby zpałacić kartą lub poprzez PayPal, kliknij na przycisk "Kup teraz" poniżej. Płatność będzie przeprowadzona przez bezpieczne połączenie internetowe serwisu .
Please notice: To the order total value a lump sum of €6,00 for package and postage cost shall be added.