• 3 convenient options to buy and send any item
  • Full order served in any of more than 1,000 stores nationwide
  • No service fee. No code or PIN required
  • Hassle-free pick-up

Order Form with Local Recipient

(Please complete the fields for successful transaction)

Customer Information

Recipient Information

Order Items

Branch Selection

Credit Card

Checkout

CUSTOMER INFORMATION
Existing Customer
Customer Code:
 Forgot Your Customer Code?

New Customer
Customer’s Name:
Complete Mailing Address:
Email Address:
Contact Numbers (area code, numbers):
Birth Date:

(Month, Day, Year)

Gender:
Civil Status:
Recipient Information
Name of Recipient:
Address of Recipient:
Contact Numbers (area code, numbers):
Order Items
Fill up form below for items you wish to order.
  • - For medicines, please indicate strength (mg, iu, etc.) and form (syrup, tablet, etc.).
    - Note that doctor’s prescription is required for prescription medicines.
  • - Prices subject to change without prior notice.

For your convenience, we offer gift certificates. As the assortment of grocery items in our stores, particularly in provincial areas, varies from store to store, we recommend that you order our Mercury Drug Gift Certificates for your requirements on grocery items. These certificates can be used for any item available in Mercury Drug stores.

Gift Certificate:
Select Mercury Drug Branch to Serve Your Order
Region:
Province/City:
Branch:
Credit Card Information

By providing your credit card details in this online facility, you agree to process payment for your order through automated online credit card payment, without need for your signature on actual credit card slips. Therefore, you voluntarily acknowledge that dispute in any form on the validity of the transaction is null and void.

Cardholder's Name:
Cardholder's Address:
Card Number (Visa and MasterCard only):
Issuing Bank
Credit Card Security Code (CVV2)

(Last 3 digits at the back of the Credit Card)

Expiry Month:
Expiry Year:
Checkout:
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Recipient Information

Address:
Contact Number:

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Ordered Items

Processing Instructions:
Additional Instructions