{"id":1378,"date":"2025-05-13T08:32:46","date_gmt":"2025-05-13T08:32:46","guid":{"rendered":"https:\/\/wordpress.themeholy.com\/medova\/?page_id=1378"},"modified":"2026-05-31T12:19:40","modified_gmt":"2026-05-31T12:19:40","slug":"nembutal-online-bestellen","status":"publish","type":"page","link":"https:\/\/barbituratenembutal.com\/nl\/order-nembutal-online\/","title":{"rendered":"Bestel Nembutal Pentobarbital"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1378\" class=\"elementor elementor-1378\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fc4aee2 e-flex e-con-boxed e-con e-parent\" data-id=\"fc4aee2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7cf761c team-details e-flex e-con-boxed e-con e-parent\" data-id=\"7cf761c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-d25f707 e-con-full e-flex e-con e-child\" data-id=\"d25f707\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b67b767 elementor-widget elementor-widget-medovasectiontitle\" data-id=\"b67b767\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"medovasectiontitle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t    <div class=\"title-area  \">\n      <span class=\"sub-title  text-anime-style-1 \">Order Form<\/span><h2 class=\"sec-title text-anime-style-3 \">Order Nembutal Online with Dignity <\/h2>    <\/div>\n\n  \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5dc417e elementor-widget elementor-widget-text-editor\" data-id=\"5dc417e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p dir=\"auto\">We understand that this is an incredibly difficult and deeply personal time. Our mission is to provide a discreet, respectful, and reliable service for those seeking a peaceful and dignified end-of-life option.<\/p><p dir=\"auto\">If you have made the thoughtful decision to take control of your final journey, we are here to support you with care and professionalism. Thousands of individuals worldwide have trusted us for safe and confidential access.<\/p><p dir=\"auto\"><strong>Order Nembutal online<\/strong> today through our secure platform. All orders are processed with the highest level of privacy and delivered discreetly to your doorstep.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-40891ed elementor-widget elementor-widget-shortcode\" data-id=\"40891ed\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><style id=\"wpforms-css-vars-2076\">\n\t\t\t\t#wpforms-2076 {\n\t\t\t\t--wpforms-field-border-radius: 6px;\n--wpforms-field-background-color: rgba(255, 255, 255, 0.8);\n--wpforms-field-border-color: #a3a9c2;\n--wpforms-field-border-color-spare: #a3a9c2;\n--wpforms-field-text-color: #6a6a6a;\n--wpforms-label-color: #000000;\n--wpforms-label-sublabel-color: #6a6a6a;\n--wpforms-label-error-color: #d80f0f;\n--wpforms-button-border-radius: 5px;\n--wpforms-button-background-color: #2f590f;\n--wpforms-button-border-color: #2f590f;\n--wpforms-container-padding: 60px;\n--wpforms-container-border-radius: 10px;\n--wpforms-background-color: #e5e6ea;\n--wpforms-background-image: stock;\n--wpforms-background-position: top right;\n--wpforms-field-menu-color: #e5e6ea;\n--wpforms-page-break-color: #2f590f;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: 0px 30px 50px -10px rgba(0, 0, 0, 0.15);\n\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-2076-custom-css\">\n\t\t\t\t#wpforms-2076 {\n\t\t\t\t\t\/* ====================== PROFESSIONAL WPFORMS STYLING - Form 2076 ====================== *\/\r\n\r\n#wpforms-2076 {\r\n    background-color: #ffffff;\r\n    padding: 40px 35px;\r\n    border-radius: 12px;\r\n    box-shadow: 0 10px 30px rgba(0, 0, 0, 0.08);\r\n    max-width: 680px;\r\n    margin: 0 auto;\r\n}\r\n\r\n\/* Labels *\/\r\n#wpforms-2076 .wpforms-field-label {\r\n    font-weight: 600;\r\n    color: #1e2937;\r\n    margin-bottom: 8px;\r\n    font-size: 15px;\r\n}\r\n\r\n\/* Fix Radio Buttons Overlap - Main Fix *\/\r\n#wpforms-2076 .wpforms-field-radio li {\r\n    margin-bottom: 20px !important;\r\n    padding: 4px 0;\r\n}\r\n\r\n#wpforms-2076 .wpforms-field-radio label {\r\n    display: flex !important;\r\n    align-items: center !important;\r\n    gap: 14px !important;\r\n    font-size: 16px;\r\n    line-height: 1.5;\r\n    cursor: pointer;\r\n}\r\n\r\n#wpforms-2076 .wpforms-field-radio input[type=\"radio\"] {\r\n    margin-right: 12px !important;\r\n    width: 20px;\r\n    height: 20px;\r\n    transform: scale(1.12);\r\n    flex-shrink: 0;\r\n}\r\n\r\n\/* Input Fields *\/\r\n#wpforms-2076 input[type=\"text\"],\r\n#wpforms-2076 input[type=\"email\"],\r\n#wpforms-2076 input[type=\"tel\"],\r\n#wpforms-2076 input[type=\"number\"],\r\n#wpforms-2076 textarea,\r\n#wpforms-2076 select {\r\n    border: 2px solid #e2e8f0;\r\n    border-radius: 8px;\r\n    padding: 14px 16px;\r\n    font-size: 16px;\r\n    color: #1e2937;\r\n    transition: all 0.3s ease;\r\n    width: 100%;\r\n    box-sizing: border-box;\r\n}\r\n\r\n#wpforms-2076 input:focus,\r\n#wpforms-2076 textarea:focus,\r\n#wpforms-2076 select:focus {\r\n    border-color: #066aab;\r\n    box-shadow: 0 0 0 3px rgba(6, 106, 171, 0.15);\r\n    outline: none;\r\n}\r\n\r\n\/* Submit Button *\/\r\n#wpforms-2076 .wpforms-submit-container button[type=\"submit\"] {\r\n    background-color: #066aab;\r\n    color: #ffffff;\r\n    font-weight: 600;\r\n    font-size: 17px;\r\n    padding: 16px 32px;\r\n    border-radius: 8px;\r\n    border: none;\r\n    transition: all 0.3s ease;\r\n    width: 100%;\r\n}\r\n\r\n#wpforms-2076 .wpforms-submit-container button[type=\"submit\"]:hover {\r\n    background-color: #05568f;\r\n    transform: translateY(-2px);\r\n    box-shadow: 0 8px 20px rgba(6, 106, 171, 0.25);\r\n}\r\n\r\n\/* Field Spacing *\/\r\n#wpforms-2076 .wpforms-field {\r\n    margin-bottom: 24px;\r\n}\r\n\r\n\/* Responsive *\/\r\n@media (max-width: 640px) {\r\n    #wpforms-2076 {\r\n        padding: 25px 20px;\r\n    }\r\n}\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-form-abandonment wpforms-render-modern\" id=\"wpforms-2076\"><form id=\"wpforms-form-2076\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2076\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/nl\/wp-json\/wp\/v2\/pages\/1378\" data-token=\"03c2820d228fcb771f69328c83068419\" data-token-time=\"1781323243\"><noscript class=\"wpforms-error-noscript\">Schakel JavaScript in je browser in om dit formulier in te vullen.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Schakel JavaScript in je browser in om dit formulier in te vullen.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-2076-field_26-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"26\"><div id=\"wpforms-2076-field_26\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-2076-field_26-error\"><h4>Fill the form below to place an order<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-2076-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2076-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-2076-field_1-error\" required><label for=\"wpforms-2076-field_1\" class=\"wpforms-field-sublabel after\">Voornaam<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2076-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-2076-field_1-last-error\" required><label for=\"wpforms-2076-field_1-last\" class=\"wpforms-field-sublabel after\">Achternaam<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-2076-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-2076-field_2\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-2076-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-2076-field_2-error\" required><\/div><div id=\"wpforms-2076-field_3-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-2076-field_3\">Phone <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-2076-field_3\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][3]\" aria-label=\"Phone\" aria-errormessage=\"wpforms-2076-field_3-error\" required><\/div><div id=\"wpforms-2076-field_16-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"16\"><div class=\"wpforms-field-layout-rows wpforms-field-large\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-2076-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-2076-field_14\">Body Weight (Lbs) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2076-field_14\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-2076-field_14-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><div id=\"wpforms-2076-field_15-container\" class=\"wpforms-field wpforms-field-number\" data-field-type=\"number\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-2076-field_15\">Age <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-2076-field_15\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][15]\" min=\"21\" max=\"150\" step=\"any\" aria-errormessage=\"wpforms-2076-field_15-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-33\"><\/div><\/div><\/div><\/div><div id=\"wpforms-2076-field_18-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-2076-field_18\">Product Formulation <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-2076-field_18\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][18]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>--- Select formulation ---<\/option><option value=\"Nembutal Powder\"  class=\"choice-1 depth-1\"  >Nembutal Powder<\/option><option value=\"Nembutal Oral Solution\"  class=\"choice-2 depth-1\"  >Nembutal Oral Solution<\/option><option value=\"Injectable Nembutal Solution\"  class=\"choice-3 depth-1\"  >Injectable Nembutal Solution<\/option><option value=\"Nembutal Pills\/tablets\"  class=\"choice-4 depth-1\"  >Nembutal Pills\/tablets<\/option><\/select><\/div>\t\t<div id=\"wpforms-2076-field_8-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"8\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-2076-field_8\" >instructions you Special<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-2076-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-2076-field_5-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"payment-multiple\" data-field-id=\"5\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (g) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2076-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-2076-field_5_1\" class=\"wpforms-payment-price\" data-amount=\"360,00\" name=\"wpforms[fields][5]\" value=\"1\" aria-errormessage=\"wpforms-2076-field_5_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_5_1\">\u00a0\u00a0\u00a0\u00a09g Nembutal Powder - <span class=\"wpforms-currency-symbol\">360,00 &euro;<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-2076-field_5_2\" class=\"wpforms-payment-price\" data-amount=\"490,00\" name=\"wpforms[fields][5]\" value=\"2\" aria-errormessage=\"wpforms-2076-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_5_2\">\u00a0 \u00a012g Nembutal Powder - <span class=\"wpforms-currency-symbol\">490,00 &euro;<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-2076-field_5_3\" class=\"wpforms-payment-price\" data-amount=\"615,00\" name=\"wpforms[fields][5]\" value=\"3\" aria-errormessage=\"wpforms-2076-field_5_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_5_3\">\u00a0 \u00a015g Nembutal Powder - <span class=\"wpforms-currency-symbol\">615,00 &euro;<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-2076-field_5_4\" class=\"wpforms-payment-price\" data-amount=\"830,00\" name=\"wpforms[fields][5]\" value=\"4\" aria-errormessage=\"wpforms-2076-field_5_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_5_4\">\u00a0 \u00a020g Nembutal Powder - <span class=\"wpforms-currency-symbol\">830,00 &euro;<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2076-field_19-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"payment-multiple\" data-field-id=\"19\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (ml) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2076-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-2076-field_19_1\" class=\"wpforms-payment-price\" data-amount=\"405,00\" name=\"wpforms[fields][19]\" value=\"1\" aria-errormessage=\"wpforms-2076-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_19_1\">\u00a0 \u00a0200ml Nembutal Oral Liquid - <span class=\"wpforms-currency-symbol\">405,00 &euro;<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-2076-field_19_4\" class=\"wpforms-payment-price\" data-amount=\"500,00\" name=\"wpforms[fields][19]\" value=\"4\" aria-errormessage=\"wpforms-2076-field_19_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_19_4\">\u00a0 \u00a0250ml Nembutal Oral Liquid - <span class=\"wpforms-currency-symbol\">500,00 &euro;<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-2076-field_19_2\" class=\"wpforms-payment-price\" data-amount=\"605,00\" name=\"wpforms[fields][19]\" value=\"2\" aria-errormessage=\"wpforms-2076-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_19_2\">\u00a0 \u00a0300ml Nembutal Oral Liquid - <span class=\"wpforms-currency-symbol\">605,00 &euro;<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-2076-field_19_3\" class=\"wpforms-payment-price\" data-amount=\"1.012,00\" name=\"wpforms[fields][19]\" value=\"3\" aria-errormessage=\"wpforms-2076-field_19_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_19_3\">\u00a0 \u00a0500ml Nembutal Oral Liquid - <span class=\"wpforms-currency-symbol\">1.012,00 &euro;<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2076-field_20-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"payment-multiple\" data-field-id=\"20\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2076-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-2076-field_20_1\" class=\"wpforms-payment-price\" data-amount=\"435,00\" name=\"wpforms[fields][20]\" value=\"1\" aria-errormessage=\"wpforms-2076-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_20_1\">\u00a0 \u00a010ml Injectable Nembutal Solution - <span class=\"wpforms-currency-symbol\">435,00 &euro;<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-2076-field_20_2\" class=\"wpforms-payment-price\" data-amount=\"870,00\" name=\"wpforms[fields][20]\" value=\"2\" aria-errormessage=\"wpforms-2076-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_20_2\">\u00a0 \u00a020ml Injectable Nembutal Solution - <span class=\"wpforms-currency-symbol\">870,00 &euro;<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-2076-field_20_3\" class=\"wpforms-payment-price\" data-amount=\"1.305,00\" name=\"wpforms[fields][20]\" value=\"3\" aria-errormessage=\"wpforms-2076-field_20_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_20_3\">\u00a0 \u00a030ml Injectable Nembutal Solution - <span class=\"wpforms-currency-symbol\">1.305,00 &euro;<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-2076-field_20_4\" class=\"wpforms-payment-price\" data-amount=\"2.175,00\" name=\"wpforms[fields][20]\" value=\"4\" aria-errormessage=\"wpforms-2076-field_20_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_20_4\">\u00a0 \u00a050ml Injectable Nembutal Solution - <span class=\"wpforms-currency-symbol\">2.175,00 &euro;<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2076-field_21-container\" class=\"wpforms-field wpforms-field-payment-multiple wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"payment-multiple\" data-field-id=\"21\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Dosage (1000mg\/tabs) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2076-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"radio\" id=\"wpforms-2076-field_21_1\" class=\"wpforms-payment-price\" data-amount=\"400,00\" name=\"wpforms[fields][21]\" value=\"1\" aria-errormessage=\"wpforms-2076-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_21_1\">\u00a0\u00a0\u00a0\u00a018 Nembutal pills - <span class=\"wpforms-currency-symbol\">400,00 &euro;<\/span><\/label><\/li><li class=\"choice-2\"><input type=\"radio\" id=\"wpforms-2076-field_21_2\" class=\"wpforms-payment-price\" data-amount=\"530,00\" name=\"wpforms[fields][21]\" value=\"2\" aria-errormessage=\"wpforms-2076-field_21_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_21_2\">\u00a0\u00a0\u00a0\u00a024 Nembutal pills - <span class=\"wpforms-currency-symbol\">530,00 &euro;<\/span><\/label><\/li><li class=\"choice-3\"><input type=\"radio\" id=\"wpforms-2076-field_21_3\" class=\"wpforms-payment-price\" data-amount=\"650,00\" name=\"wpforms[fields][21]\" value=\"3\" aria-errormessage=\"wpforms-2076-field_21_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_21_3\">\u00a0\u00a0\u00a0\u00a030 Nembutal pills - <span class=\"wpforms-currency-symbol\">650,00 &euro;<\/span><\/label><\/li><li class=\"choice-4\"><input type=\"radio\" id=\"wpforms-2076-field_21_4\" class=\"wpforms-payment-price\" data-amount=\"1.310,00\" name=\"wpforms[fields][21]\" value=\"4\" aria-errormessage=\"wpforms-2076-field_21_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_21_4\">\u00a0\u00a0\u00a0\u00a040 Nembutal pills - <span class=\"wpforms-currency-symbol\">1.310,00 &euro;<\/span><\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2076-field_22-container\" class=\"wpforms-field wpforms-field-payment-checkbox wpforms-list-inline\" data-field-type=\"payment-checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Additional Options<\/legend><ul id=\"wpforms-2076-field_22\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_22_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 576 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M112 96c-26.5 0-48 21.5-48 48V256h96V144c0-26.5-21.5-48-48-48zM0 144C0 82.1 50.1 32 112 32s112 50.1 112 112V368c0 61.9-50.1 112-112 112S0 429.9 0 368V144zM554.9 399.4c-7.1 12.3-23.7 13.1-33.8 3.1L333.5 214.9c-10-10-9.3-26.7 3.1-33.8C360 167.7 387.1 160 416 160c88.4 0 160 71.6 160 160c0 28.9-7.7 56-21.1 79.4zm-59.5 59.5C472 472.3 444.9 480 416 480c-88.4 0-160-71.6-160-160c0-28.9 7.7-56 21.1-79.4c7.1-12.3 23.7-13.1 33.8-3.1L498.5 425.1c10 10 9.3 26.7-3.1 33.8z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-2076-field_22_1\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"15,00\" name=\"wpforms[fields][22][]\" value=\"1\" aria-errormessage=\"wpforms-2076-field_22_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Zofran (antiemetic pills) - <span class=\"wpforms-currency-symbol\">15,00 &euro;<\/span><\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_22_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M112 0C85.5 0 64 21.5 64 48V96H16c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 272c8.8 0 16 7.2 16 16s-7.2 16-16 16H64 48c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 240c8.8 0 16 7.2 16 16s-7.2 16-16 16H64 16c-8.8 0-16 7.2-16 16s7.2 16 16 16H64 208c8.8 0 16 7.2 16 16s-7.2 16-16 16H64V416c0 53 43 96 96 96s96-43 96-96H384c0 53 43 96 96 96s96-43 96-96h32c17.7 0 32-14.3 32-32s-14.3-32-32-32V288 256 237.3c0-17-6.7-33.3-18.7-45.3L512 114.7c-12-12-28.3-18.7-45.3-18.7H416V48c0-26.5-21.5-48-48-48H112zM544 237.3V256H416V160h50.7L544 237.3zM160 368a48 48 0 1 1 0 96 48 48 0 1 1 0-96zm272 48a48 48 0 1 1 96 0 48 48 0 1 1 -96 0z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-2076-field_22_2\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"50,00\" name=\"wpforms[fields][22][]\" value=\"2\" aria-errormessage=\"wpforms-2076-field_22_2-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Express Shipping - <span class=\"wpforms-currency-symbol\">50,00 &euro;<\/span><\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_22_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 640 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M480 416h96c35.3 0 64-28.7 64-64V160c0-35.3-28.7-64-64-64H480V416zM448 96H192V416H448V96zM64 96C28.7 96 0 124.7 0 160V352c0 35.3 28.7 64 64 64h96V96H64zM248 208a24 24 0 1 1 48 0 24 24 0 1 1 -48 0zm120-24a24 24 0 1 1 0 48 24 24 0 1 1 0-48zM248 304a24 24 0 1 1 48 0 24 24 0 1 1 -48 0zm120-24a24 24 0 1 1 0 48 24 24 0 1 1 0-48z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-2076-field_22_3\" class=\"wpforms-payment-price wpforms-screen-reader-element\" data-amount=\"35,00\" name=\"wpforms[fields][22][]\" value=\"3\" aria-errormessage=\"wpforms-2076-field_22_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Barbiturate test kit - <span class=\"wpforms-currency-symbol\">35,00 &euro;<\/span><\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2076-field_4-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2076-field_4\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][4][address1]\" aria-errormessage=\"wpforms-2076-field_4-error\" required><label for=\"wpforms-2076-field_4\" class=\"wpforms-field-sublabel after\">Adres regel 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2076-field_4-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][4][address2]\" aria-errormessage=\"wpforms-2076-field_4-address2-error\" ><label for=\"wpforms-2076-field_4-address2\" class=\"wpforms-field-sublabel after\">Adres regel 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2076-field_4-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][4][city]\" aria-errormessage=\"wpforms-2076-field_4-city-error\" required><label for=\"wpforms-2076-field_4-city\" class=\"wpforms-field-sublabel after\">Stad<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2076-field_4-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][4][state]\" aria-errormessage=\"wpforms-2076-field_4-state-error\" required><label for=\"wpforms-2076-field_4-state\" class=\"wpforms-field-sublabel after\">Staat \/ Provincie \/ Regio<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2076-field_4-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][4][postal]\" aria-errormessage=\"wpforms-2076-field_4-postal-error\" required><label for=\"wpforms-2076-field_4-postal\" class=\"wpforms-field-sublabel after\">Postcode<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2076-field_4-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][4][country]\" aria-errormessage=\"wpforms-2076-field_4-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Selecteer country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albani\u00eb<\/option><option value=\"DZ\" >Algerije<\/option><option value=\"AS\" >Amerikaans Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua en Barbuda<\/option><option value=\"AR\" >Argentini\u00eb<\/option><option value=\"AM\" >Armeni\u00eb<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australi\u00eb<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgi\u00eb<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Sint Eustatius en Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouveteiland<\/option><option value=\"BR\" >Brazili\u00eb<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgarije<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocoseilanden<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoren<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cookeilanden<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"DK\" >Denemarken<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"DE\" >Duitsland<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypte<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estland<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopi\u00eb<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >Frankrijk<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GR\" >Griekenland<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongarije<\/option><option value=\"IS\" >IJsland<\/option><option value=\"IE\" >Ierland (Republiek van)<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesi\u00eb<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (Islamitische Republiek van)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Itali\u00eb<\/option><option value=\"CI\" >Ivoorkust<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordani\u00eb<\/option><option value=\"KY\" >Kaaiman Eilanden<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenia<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"HR\" >Kroati\u00eb<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Laos (Democratische Volksrepubliek)<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Letland<\/option><option value=\"LB\" >Libanon<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libi\u00eb<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithouwen<\/option><option value=\"LU\" >Luxemburg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Malediven<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MA\" >Marokko<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federale Staten van)<\/option><option value=\"MD\" >Moldavi\u00eb<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongoli\u00eb<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands, The<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NZ\" >Nieuw-Zeeland<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"MK\" >Noord Macedoni\u00eb (Republiek van)<\/option><option value=\"KP\" >Noord-Korea (Democratische Volksrepubliek)<\/option><option value=\"NO\" >Noorwegen<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"UA\" >Oekraine<\/option><option value=\"OM\" >Oman<\/option><option value=\"AT\" >Oostenrijk<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestina<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Polen<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roemeni\u00eb<\/option><option value=\"RU\" >Russische Federatie<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabi\u00eb<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Servi\u00eb<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SI\" >Sloveni\u00eb<\/option><option value=\"SK\" >Slowakije<\/option><option value=\"SD\" >Soedan<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spanje<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard en Jan Mayen<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republiek China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"CZ\" >Tsjechi\u00eb<\/option><option value=\"TN\" >Tunesi\u00eb<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vaticaanstad<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"ZA\" >Zuid Afrika<\/option><option value=\"KR\" >Zuid-Korea (Republiek van)<\/option><option value=\"SE\" >Zweden<\/option><option value=\"CH\" >Zwitserland<\/option><option value=\"AX\" >\u00c5land<\/option><\/select><label for=\"wpforms-2076-field_4-country\" class=\"wpforms-field-sublabel after\">Land<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-2076-field_24-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline\" data-field-type=\"checkbox\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">How do you want us to Contact you?<\/legend><ul id=\"wpforms-2076-field_24\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #227021;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_24_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M64 112c-8.8 0-16 7.2-16 16v22.1L220.5 291.7c20.7 17 50.4 17 71.1 0L464 150.1V128c0-8.8-7.2-16-16-16H64zM48 212.2V384c0 8.8 7.2 16 16 16H448c8.8 0 16-7.2 16-16V212.2L322 328.8c-38.4 31.5-93.7 31.5-132 0L48 212.2zM0 128C0 92.7 28.7 64 64 64H448c35.3 0 64 28.7 64 64V384c0 35.3-28.7 64-64 64H64c-35.3 0-64-28.7-64-64V128z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-2076-field_24_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"E-mail\" aria-errormessage=\"wpforms-2076-field_24_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">E-mail<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item wpforms-selected\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_24_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M347.1 24.6c7.7-18.6 28-28.5 47.4-23.2l88 24C499.9 30.2 512 46 512 64c0 247.4-200.6 448-448 448c-18 0-33.8-12.1-38.6-29.5l-24-88c-5.3-19.4 4.6-39.7 23.2-47.4l96-40c16.3-6.8 35.2-2.1 46.3 11.6L207.3 368c70.4-33.3 127.4-90.3 160.7-160.7L318.7 167c-13.7-11.2-18.4-30-11.6-46.3l40-96z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-2076-field_24_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"PhoneCall\" aria-errormessage=\"wpforms-2076-field_24_2-error\"   checked='checked'>\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">PhoneCall<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_24_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 448 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M380.9 97.1C339 55.1 283.2 32 223.9 32c-122.4 0-222 99.6-222 222 0 39.1 10.2 77.3 29.6 111L0 480l117.7-30.9c32.4 17.7 68.9 27 106.1 27h.1c122.3 0 224.1-99.6 224.1-222 0-59.3-25.2-115-67.1-157zm-157 341.6c-33.2 0-65.7-8.9-94-25.7l-6.7-4-69.8 18.3L72 359.2l-4.4-7c-18.5-29.4-28.2-63.3-28.2-98.2 0-101.7 82.8-184.5 184.6-184.5 49.3 0 95.6 19.2 130.4 54.1 34.8 34.9 56.2 81.2 56.1 130.5 0 101.8-84.9 184.6-186.6 184.6zm101.2-138.2c-5.5-2.8-32.8-16.2-37.9-18-5.1-1.9-8.8-2.8-12.5 2.8-3.7 5.6-14.3 18-17.6 21.8-3.2 3.7-6.5 4.2-12 1.4-32.6-16.3-54-29.1-75.5-66-5.7-9.8 5.7-9.1 16.3-30.3 1.8-3.7.9-6.9-.5-9.7-1.4-2.8-12.5-30.1-17.1-41.2-4.5-10.8-9.1-9.3-12.5-9.5-3.2-.2-6.9-.2-10.6-.2-3.7 0-9.7 1.4-14.8 6.9-5.1 5.6-19.4 19-19.4 46.3 0 27.3 19.9 53.7 22.6 57.4 2.8 3.7 39.1 59.7 94.8 83.8 35.2 15.2 49 16.5 66.6 13.9 10.7-1.6 32.8-13.4 37.4-26.4 4.6-13 4.6-24.1 3.2-26.4-1.3-2.5-5-3.9-10.5-6.6z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"checkbox\" id=\"wpforms-2076-field_24_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][24][]\" value=\"Whatsapp\" aria-errormessage=\"wpforms-2076-field_24_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Whatsapp<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2076-field_25-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Multiple Choice<\/legend><ul id=\"wpforms-2076-field_25\" class=\"wpforms-icon-choices wpforms-icon-choices-default wpforms-icon-choices-small\" style=\"--wpforms-icon-choices-color: #066aab;\"><li class=\"choice-1 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_25_1\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M243.4 2.6l-224 96c-14 6-21.8 21-18.7 35.8S16.8 160 32 160v8c0 13.3 10.7 24 24 24H456c13.3 0 24-10.7 24-24v-8c15.2 0 28.3-10.7 31.3-25.6s-4.8-29.9-18.7-35.8l-224-96c-8-3.4-17.2-3.4-25.2 0zM128 224H64V420.3c-.6 .3-1.2 .7-1.8 1.1l-48 32c-11.7 7.8-17 22.4-12.9 35.9S17.9 512 32 512H480c14.1 0 26.5-9.2 30.6-22.7s-1.1-28.1-12.9-35.9l-48-32c-.6-.4-1.2-.7-1.8-1.1V224H384V416H344V224H280V416H232V224H168V416H128V224zM256 64a32 32 0 1 1 0 64 32 32 0 1 1 0-64z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-2076-field_25_1\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Bank Transfer\" aria-errormessage=\"wpforms-2076-field_25_1-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Bank Transfer<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-2 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_25_2\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M504 256c0 136.967-111.033 248-248 248S8 392.967 8 256 119.033 8 256 8s248 111.033 248 248zm-141.651-35.33c4.937-32.999-20.191-50.739-54.55-62.573l11.146-44.702-27.213-6.781-10.851 43.524c-7.154-1.783-14.502-3.464-21.803-5.13l10.929-43.81-27.198-6.781-11.153 44.686c-5.922-1.349-11.735-2.682-17.377-4.084l.031-.14-37.53-9.37-7.239 29.062s20.191 4.627 19.765 4.913c11.022 2.751 13.014 10.044 12.68 15.825l-12.696 50.925c.76.194 1.744.473 2.829.907-.907-.225-1.876-.473-2.876-.713l-17.796 71.338c-1.349 3.348-4.767 8.37-12.471 6.464.271.395-19.78-4.937-19.78-4.937l-13.51 31.147 35.414 8.827c6.588 1.651 13.045 3.379 19.4 5.006l-11.262 45.213 27.182 6.781 11.153-44.733a1038.209 1038.209 0 0 0 21.687 5.627l-11.115 44.523 27.213 6.781 11.262-45.128c46.404 8.781 81.299 5.239 95.986-36.727 11.836-33.79-.589-53.281-25.004-65.991 17.78-4.098 31.174-15.792 34.747-39.949zm-62.177 87.179c-8.41 33.79-65.308 15.523-83.755 10.943l14.944-59.899c18.446 4.603 77.6 13.717 68.811 48.956zm8.417-87.667c-7.673 30.736-55.031 15.12-70.393 11.292l13.548-54.327c15.363 3.828 64.836 10.973 56.845 43.035z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-2076-field_25_2\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Crypto\" aria-errormessage=\"wpforms-2076-field_25_2-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Crypto<\/span>\n\t\t\t<\/label><\/li><li class=\"choice-3 depth-1 wpforms-icon-choices-item\"><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_25_3\">\n\t\t\t\t<span class=\"wpforms-icon-choices-icon\">\n\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"40\" height=\"32\" viewBox=\"0 0 512 512\"><!--! Font Awesome Free 6.4.0 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M326.7 403.7c-22.1 8-45.9 12.3-70.7 12.3s-48.7-4.4-70.7-12.3c-.3-.1-.5-.2-.8-.3c-30-11-56.8-28.7-78.6-51.4C70 314.6 48 263.9 48 208C48 93.1 141.1 0 256 0S464 93.1 464 208c0 55.9-22 106.6-57.9 144c-1 1-2 2.1-3 3.1c-21.4 21.4-47.4 38.1-76.3 48.6zM256 91.9c-11.1 0-20.1 9-20.1 20.1v6c-5.6 1.2-10.9 2.9-15.9 5.1c-15 6.8-27.9 19.4-31.1 37.7c-1.8 10.2-.8 20 3.4 29c4.2 8.8 10.7 15 17.3 19.5c11.6 7.9 26.9 12.5 38.6 16l2.2 .7c13.9 4.2 23.4 7.4 29.3 11.7c2.5 1.8 3.4 3.2 3.7 4c.3 .8 .9 2.6 .2 6.7c-.6 3.5-2.5 6.4-8 8.8c-6.1 2.6-16 3.9-28.8 1.9c-6-1-16.7-4.6-26.2-7.9l0 0 0 0 0 0c-2.2-.7-4.3-1.5-6.4-2.1c-10.5-3.5-21.8 2.2-25.3 12.7s2.2 21.8 12.7 25.3c1.2 .4 2.7 .9 4.4 1.5c7.9 2.7 20.3 6.9 29.8 9.1V304c0 11.1 9 20.1 20.1 20.1s20.1-9 20.1-20.1v-5.5c5.3-1 10.5-2.5 15.4-4.6c15.7-6.7 28.4-19.7 31.6-38.7c1.8-10.4 1-20.3-3-29.4c-3.9-9-10.2-15.6-16.9-20.5c-12.2-8.8-28.3-13.7-40.4-17.4l-.8-.2c-14.2-4.3-23.8-7.3-29.9-11.4c-2.6-1.8-3.4-3-3.6-3.5c-.2-.3-.7-1.6-.1-5c.3-1.9 1.9-5.2 8.2-8.1c6.4-2.9 16.4-4.5 28.6-2.6c4.3 .7 17.9 3.3 21.7 4.3c10.7 2.8 21.6-3.5 24.5-14.2s-3.5-21.6-14.2-24.5c-4.4-1.2-14.4-3.2-21-4.4V112c0-11.1-9-20.1-20.1-20.1zM48 352H64c19.5 25.9 44 47.7 72.2 64H64v32H256 448V416H375.8c28.2-16.3 52.8-38.1 72.2-64h16c26.5 0 48 21.5 48 48v64c0 26.5-21.5 48-48 48H48c-26.5 0-48-21.5-48-48V400c0-26.5 21.5-48 48-48z\"\/><\/svg>\n\t\t\t\t\t<span class=\"wpforms-icon-choices-icon-bg\"><\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"radio\" id=\"wpforms-2076-field_25_3\" class=\"wpforms-screen-reader-element\" name=\"wpforms[fields][25]\" value=\"Other\" aria-errormessage=\"wpforms-2076-field_25_3-error\"  >\n\t\t\t\t<span class=\"wpforms-icon-choices-label\">Other<\/span>\n\t\t\t<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-2076-field_7-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-2076-field_7\">Special instructions (optional)<\/label><textarea id=\"wpforms-2076-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-2076-field_7-error\" ><\/textarea><\/div><div id=\"wpforms-2076-field_6-container\" class=\"wpforms-field wpforms-field-payment-total wpforms-conditional-field wpforms-conditional-show wpforms-field-medium wpforms-summary-enabled\" data-field-type=\"payment-total\" data-field-id=\"6\" style=\"display:none;\" aria-live=\"polite\" aria-atomic=\"true\"><label class=\"wpforms-field-label\">Order Summary<\/label><div class=\"wpforms-order-summary-container\">\n\t<table class=\"wpforms-order-summary-preview\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\" role=\"presentation\">\n\t\t<caption style=\"display: none;\">Besteloverzicht<\/caption>\n\t\t<thead>\n\t\t\t<tr>\n\t\t\t\t<th class=\"wpforms-order-summary-item-label\" valign=\"top\">Item<\/th>\n\t\t\t\t<th class=\"wpforms-order-summary-item-quantity\" valign=\"top\">\n\t\t\t\t\t<span class=\"wpforms-order-summary-item-quantity-label-full\">Hoeveelheid<\/span>\n\t\t\t\t\t<span class=\"wpforms-order-summary-item-quantity-label-short\">Hoeveelheid<\/span>\n\t\t\t\t<\/th>\n\t\t\t\t<th class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">Totaal<\/th>\n\t\t\t<\/tr>\n\t\t<\/thead>\n\t\t<tbody>\n\t\t\t<tr class=\"wpforms-order-summary-placeholder\" style=\"display: table-row;\">\n\t\t\t\t<td colspan=\"3\" valign=\"top\">Er zijn nog geen producten geselecteerd.<\/td>\n\t\t\t<\/tr>\n\t\t\t<tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - \u00a0\u00a0\u00a0\u00a09g Nembutal Powder<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">360,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - \u00a0 \u00a012g Nembutal Powder<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">490,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - \u00a0 \u00a015g Nembutal Powder<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">615,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"5\" data-choice=\"4\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (g) - \u00a0 \u00a020g Nembutal Powder<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">830,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - \u00a0 \u00a0200ml Nembutal Oral Liquid<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">405,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"4\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - \u00a0 \u00a0250ml Nembutal Oral Liquid<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">500,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - \u00a0 \u00a0300ml Nembutal Oral Liquid<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">605,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"19\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (ml) - \u00a0 \u00a0500ml Nembutal Oral Liquid<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">1.012,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - \u00a0 \u00a010ml Injectable Nembutal Solution<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">435,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - \u00a0 \u00a020ml Injectable Nembutal Solution<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">870,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - \u00a0 \u00a030ml Injectable Nembutal Solution<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">1.305,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"20\" data-choice=\"4\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage - \u00a0 \u00a050ml Injectable Nembutal Solution<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">2.175,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - \u00a0\u00a0\u00a0\u00a018 Nembutal pills<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">400,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - \u00a0\u00a0\u00a0\u00a024 Nembutal pills<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">530,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - \u00a0\u00a0\u00a0\u00a030 Nembutal pills<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">650,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"21\" data-choice=\"4\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Dosage (1000mg\/tabs) - \u00a0\u00a0\u00a0\u00a040 Nembutal pills<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">1.310,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"1\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Zofran (antiemetic pills)<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">15,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"2\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Express Shipping<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">50,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-field\" data-field=\"22\" data-choice=\"3\" style=\"display:none;\"><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Additional Options - Barbiturate test kit<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\">1<\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">35,00 &euro;<\/td><\/tr><tr class=\"wpforms-order-summary-preview-total\" ><td class=\"wpforms-order-summary-item-label\" valign=\"top\">Totaal<\/td><td class=\"wpforms-order-summary-item-quantity\" valign=\"top\"><\/td><td class=\"wpforms-order-summary-item-price\" valign=\"top\" style=\"width:11ch;\">0,00 &euro;<\/td><\/tr>\t\t<\/tbody>\n\t<\/table>\n<\/div>\n<div class=\"wpforms-payment-total\" style=\"display:none\">0,00 &euro;<\/div><input type=\"hidden\" id=\"wpforms-2076-field_6\" class=\"wpforms-field-medium wpforms-payment-total\" name=\"wpforms[fields][6]\" value=\"0\"><\/div><div id=\"wpforms-2076-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Acknowledgement <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-2076-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-2076-field_28_1\" name=\"wpforms[fields][28][]\" value=\"\u00a0\u00a0&lt;strong&gt;I have read, understood, and agree to the following:&lt;\/strong&gt;&lt;br&gt;&lt;br&gt;\" aria-errormessage=\"wpforms-2076-field_28_1-error\" aria-describedby=\"wpforms-2076-field_28-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2076-field_28_1\">\u00a0\u00a0<strong>I have read, understood, and agree to the following:<\/strong><br><br><\/label><\/li><\/ul><div id=\"wpforms-2076-field_28-description\" class=\"wpforms-field-description\"><div class=\"disclaimer-text\" style=\"margin:20px 0;padding:15px;border:1px solid #e0e0e0;background-color:#f8f8f8;font-size:15px;line-height:1.6;\">\n    \n    I am a legal adult (18+ years old) and I am placing this order <strong>solely at my own risk and responsibility<\/strong>.<br \/><br \/>\n    \n    I acknowledge that <strong>Nembutal (pentobarbital)<\/strong> is a powerful controlled substance. 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url('https:\/\/barbituratenembutal.com\/wp-content\/uploads\/2026\/04\/end-of-life-care.png');\">\r\n            <div class=\"offer-banner\">\r\n                                    <h4 class=\"banner-title\">We know this journey isn\u2019t easy\u2014emotionally, legally, or practically<\/h4>\r\n                                                    <a href=\"https:\/\/barbituratenembutal.com\/contact-us\/\" class=\"th-btn style1\"\r\n                                              >\r\n                        Contact us                    <\/a>\r\n                            <\/div>\r\n        <\/div>\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Bestelformulier Bestel Nembutal Online met Waardigheid We begrijpen dat dit een ongelooflijk moeilijke en zeer persoonlijke tijd is. Onze missie is het bieden van een discrete, respectvolle en betrouwbare service voor diegenen die op zoek zijn naar een vreedzame en waardige optie voor het levenseinde. Als je de weloverwogen beslissing hebt genomen om je laatste reis in eigen hand te nemen, zijn wij...<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-builder.php","meta":{"inline_featured_image":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-1378","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.5 (Yoast SEO v27.5) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Order Nembutal Online | Secure Pentobarbital Purchase Form<\/title>\n<meta name=\"description\" content=\"Securely order Nembutal (all forms) online. Fast processing, discreet shipping to Europe, and 24\/7 support. 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