Mail Order Form International Send To Printer
Prices are listed in U.S. Currency. There is an online currency converter here: http://www.xe.com/ucc/ We accept checks, international money orders, and bank drafts.
Ship To Information: Name: Address 1: Address 2: City: Province: Postal Code: Country: Telephone: Email address: Is this your first time taking a B5 vitamin therapy? No .........................................Yes
Ship To Information:
Name:
Address 1: Address 2:
City: Province: Postal Code: Country:
Telephone:
Email address:
Is this your first time taking a B5 vitamin therapy?
No .........................................Yes
Order Information. (price includes $14.95 shipping) I would like to order:
1 bottle of B5 Supplements..............$54.90
2 bottles of B5 Supplements..............$94.85
3 bottles of B5 Supplements..............$134.80
1 bottle of B5 Supplements and 1 Skin Advancement System ......................................$84.85 other (please write below)
(please write in and calculate total if ordering more than 3 bottles, or if you would like to order a different product. Shipping is a flat $14.95 regardless of order size.)
Please print this page and mail with check or money order to:
Evolution-X 11470 Sunrise Gold Circle #4 Rancho Cordova, CA 95742 United States
