BY CLICKING "AGREE" BELOW I CONFIRM THAT:

IF PLACING THIS ORDER AS A CUSTOMER, I, ON BEHALF OF MYSELF, MY HEIRS, ASSIGNS AND SUCCESSORS, HEREBY AGREE TO ALL OF THE FOLLOWING TERMS AND CONDITIONS, REPRESENT THAT I UNDERSTAND ALL OF THE FOLLOWING TERMS AND CONDITIONS AND THAT I HAVE HAD ADEQUATE OPPORTUNITY TO CONSULT ANY ADVISORS NECESSARY, WHETHER MEDICAL, LEGAL OR OTHERWISE.

IF I AM PLACING THE ORDER ON BEHALF OF SOMEONE ELSE, I REPRESENT THAT I HAVE ALL NECESSARY CONSENT, PERMISSION AND AUTHORIZATION TO DO SO ON BEHALF OF THAT PERSON AND THEIR HEIRS, ASSIGNS AND SUCCESSORS AND THE PERSON I REPRESENT AGREES TO ALL OF THE FOLLOWING TERMS AND CONDITIONS, UNDERSTANDS ALL OF THE FOLLOWING TERMS AND CONDITIONS AND HAS HAD AN ADEQUATE OPPORTUNITY TO CONSULT ANY ADVISORS NECESSARY, WHETHER MEDICAL, LEGAL OR OTHERWISE.

AUTHORIZATION AND CONSENT

I hereby appoint Paylessformeds.com and the partnered Canadian Pharmacy as my agent and attorney for the purposes of obtaining a prescription from a Medical Doctor in Canada (the "Canada MD") which corresponds to the prescription included in this order, which may include directly contacting my prescribing physician, and purchasing and arranging delivery of the medications prescribed in the Canadian prescription, substantially on the terms set forth below, all to the same extent I could if I personally took such steps.

I hereby consent to Paylessformeds.com, the Canada MD and any pharmacy supplying my order, collecting my personal and medical information, maintaining the information necessary to quickly process future orders which may include retaining on file my name, address, phone number, payment and other information and verifying future orders.

I confirm that my personal information will be handled only by Paylessformeds.com's order-processing employees and contractors (including physicians and nurses, pharmacists and pharmacy technicians) according to the Privacy Policy as posted on the Paylessformeds.com web site which may be updated from time to time.

DISCLOSURE AND REPRESENTATIONS

I represent that all of the following statements are true and agree that Paylessformeds.com and the Canadian pharmacists and pharmacy technicians are relying on these representations:

>I am of the age of majority or older where I reside;
>I can make my own medical decisions according to the law of the place I reside;
>The prescription I am requesting Paylessformeds.com to assist me in obtaining was prescribed by a qualified physician licensed where I obtained the prescription;
>The prescription I am requesting Paylessformeds.com to assist me in obtaining has not been altered in any way nor has it been filled prior to submission to Paylessformeds.com.
>I agree to immediately destroy all copies of my prescription once it has been filled;
>I am not violating any laws where I reside by placing this order;
>I will use any medication obtained for me by Paylessformeds.com strictly according to the instructions provided by the physician who prescribed the medication;
>I am not seeking or relying on any medical information from Paylessformeds.com and I have consulted with a licensed physician where I obtained the prescription within the last year; 
>I will immediately contact the physician who provided my prescription included with this order in the event I suffer any unexpected side effects from any medication obtained for me by Paylessformeds.com.
>Paylessformeds.com has made no representations or warranties to me, representations or warranties with respect to any delivered medications for a particular purpose (including, without limitation, its appropriateness for curing or helping relieve any particular , illness or disease, or its potential or actual side or adverse effects whether previously known or unknown).

PURCHASE AND SALE TERMS

Paylessformeds.com's affiliated pharmacy will charge my credit card the following amounts: the medication price (in U.S. dollars) as posted on the Paylessformeds.com web site on the day Paylessformeds.com receives my order, U.S. $15.00 for each package Paylessformeds.com ships and any applicable taxes.

In the event my payment is not authorized, Paylessformeds.com has the right to cancel my order and attempt to provide me with notice of such cancellation.

Paylessformeds.com, and the reserves the right to refuse to assist me in obtaining any order in its sole discretion, in which event I will be entitled to a refund for monies paid for such order.

Wherever possible the Pharmacy substitute prescription drugs with lower cost generic drugs; the Pharmacy does not fill any orders using child protection packaging.

The Pharmacy does not provide its agent or attorney services as a substitute for health care or the advice of a physician.

The Pharmacy will not exchange medication or return any monies paid once an order is filled, unless the medication provided to me by the supplying pharmacy does not correspond with my prescription.

RELEASE AND WAIVER

I hereby release and save Paylessformeds.com and its employees and contractors (including physicians and nurses, pharmacists and pharmacy technicians) harmless from any and all suits, demands, liabilities, claims, actions, expenses, losses and damages of any kind or nature whatsoever, including, without limitation, general, direct, special, indirect and consequential damages and costs of litigation (including reasonable attorney fees) arising from:

My use of the medication obtained for me by Paylessformeds.com including, without limitation, any and all side effects whether previously known or unknown;

Paylessformeds.com's or its contractors' manner or timeliness of completing any actions I have authorized above, including, without limitation, their manner or timeliness in prescribing the appropriate strength, dosage, or dispensing generic drugs and non-child-protective packaging; and

My breach of any terms, conditions or representations or warranties in this agreement.

Nothing in this release shall be deemed to release any Paylessformeds.com pharmacy or pharmacist contractors from compliance with the applicable standards of practice or usual professional duties and obligations which a pharmacist owes.

GOVERNING LAW

This agreement, along with any disputes that may arise, will be governed by and construed in accordance with the laws of the province of Manitoba, Canada.

I have read and understood all of the foregoing.