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Epherdine Registration Form

If you have any questions regarding ingredients with this form,
please call 215-620-7776 or email to supervita@comcast.net
Monday-Friday, 8:00 am - 4:00 pm EST

Ephedrine hcl Order Requirements

This form must be filled out for Ephedrine hcl customers. After this form has been received by Supervita.com and it is on file, you won’t be required to submit again unless regulations change. Please fill out this form in its entirety. If any information is missing, your order cannot be processed. Your ID image must be smaller than 16 megabytes, if you require assistance please contact us. Please upload your image in GIF, JPEG, TIFF, or PNG format.

Name
Current Address
City
State (or Country if outside US)
Zip (or foreign equivalent
Date of Birth
Phone Number
Email address
Driver’s License/ State ID Card
The personal information you provide is for our internal use only. Your information will be kept absolutely confidential and handled responsibly. It will not be given, sold or lent to any third-party organizations.

And please submit to one of the following:
Fax: (267) 282-5356
Email: supervita@comcast.net with
Scan (with driver’s license attached)
Mail: Supervita.com 217 Willow Drive,
Warminster, Pa 18974-3744

Mega Pro’s

Vasopro
Ephedrine HCL

Mega Pro’s

Vasopro Soft
Gels 24 count

Ephedrine Plus

24 count 12.5mg
of ephedrine hcl