Bust Firm Mail / Fax Order Form
 *Print this page, fill out all information, and send this form by mail or fax to:
Cosmeceutical Technologies Inc


FAX: 310-822-0650

1.

Customer Information

Name:

Address:

City:

State:

 Zip:

Country:

Phone:

Email:
 

2.

Payment Method

Select one

Money Order / Cashiers Check (Payable to CTI US$ only)

Visa / MasterCard / American Express (circle one)

Credit Card Number:

Expiration Date:

/  Signature: _________________________

3.

Select Products

Single bottle of Perfect Woman Toning and Firming Lotion

$39.95

Buy 2 bottles of Toning and Firming Lotion Get 1 bottle Free
(3 Month Supply )

 $79.90

Buy 3 bottlse of Toning and Firming Lotion Get 3 bottles Free
(6 Month Supply )

$119.85

Detoxify - 1 bottle

$29.95

Subtotal:

$.

Shipping (US orders $9.95, international orders $24.95)

$.

Grand Total:

$.

4.

 

Mail Order Form to:

Cosmeceutical Technologies Inc

or Fax This Form to:s

310-822-0650