Special Payment Arrangements

If have contracted with FemCap for alternative payment arrangements, or if you are a clinician and need to submit payment, please follow these steps:

Fill out the form below using your credit card's BILLING information.
OPTIONAL - Enter your shipping information (if different than the billing information).
Click "Confirm Order" to see final payment details before being redirected to our secure payment gateway.

If you have any questions please Contact Us for assistance.

Billing Information First Name *
Last Name *
Address Line 1 *
Address Line 2
Country *
State/Province *
City *
ZIP/Postal Code *

Phone Number *
Fax Number
Email Address *

Shipping Information

Standard Shipping

Destination

Ship to Billing Address
Ship to Another Location:

Order Information Purchase Amount (USD): *

The information provided on these pages is intended for use by our customers and health care professionals in the United States. Nothing on this website should be construed as the giving of medical advice or the making of a recommendation, and it should not be relied on as the basis for any decision or action. Only your health care professional can advise you on your specific situation. FemCap, Inc., values your privacy. Click here for our privacy policy. FemCap recognizes that the Internet is a global communications medium; however, laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country. Some information included here may not be appropriate for use outside the United States.

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