Dermacure Order Page™
For faster delivery you may order
online using your credit card or print
this
form and fax it to (607) 936-8307. To place an order via "snail mail"
print
this order form, fill it out, and mail it with your check, money order
or credit card information to:
SELECT PRODUCTS
Dept. HS
P. O. Box 667
Elmira, NY 14902
United States of America
NOTE: IF YOU DON'T HAVE A
PRINTER,
BUT WISH TO MAIL US YOUR ORDER, SIMPLY WRITE THE INFORMATION ON A PIECE
OF PAPER.
You may also order with your credit or
debit card by calling
(607) 936-4617. For inquiries call (607)
936-4617.
You can also pay by using Paypal. Our Paypal
email address is aguacero10@aol.com
Click
Here>>>To Order Online With Complete Security and
Confidentiality.
| Sizes |
Quantity |
Cost Ea. |
Total |
| (One 3 ounce
Jar) Small |
|
$24.95 |
| (One 6 ounce
Jar) Medium |
|
$39.95 |
| (2 Jars = 9 ounces)
Large |
|
$53.95 |
| (2 Jars = 12 ounces) X-Large |
|
$64.95 |
Prices include postage inside the continental United States. All others
add $13.00 US Shipping/Handling.
| Name: |
______________________________________ |
| Address: |
______________________________________ |
| City: |
_______________State:____________Zip:__________ |
| Country: |
______________________________________ |
Email Address:
__________________________________
Phone No.:
______________________________________
For credit card orders:
Type:______________________
No._________________________________
Exp. Date:__________________
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