Single Travel RX Pill Case Reward Survey
Thank you for supporting the Travel RX pill case project! We're working hard to get these pill cases made and in your hands. Please provide a reliable shipping address, your contact information, and make selections for your reward tier.

Note: Pledges via Kickstarter are closed, so this survey is for selecting the color options for the cases you already purchased. If anyone would still like to order additional Travel RX pill cases they may do so at https://www.indiegogo.com/projects/travel-rx-rugged-magnetic-pill-case.

Country*

Country*

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Full name*

Full name*

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Address*

Address*

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Address 2

Address 2

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City*

City*

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State/Province/Region*

State/Province/Region*

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Postal Code*

Postal Code*

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Phone Number*

Phone Number*

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Delivery Notes

Delivery Notes

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Choose your Travel RX pill case color*

Choose your Travel RX pill case color*

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We hate mailing lists as much as anyone, but we'd like to tell you about our future Kickstarters. Would you like to be on our mailing list?*

We hate mailing lists as much as anyone, but we'd like to tell you about our future Kickstarters. Would you like to be on our mailing list?*

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Let us know if there is anything else we need to know about your order.

Let us know if there is anything else we need to know about your order.

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