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

FAX: 310-822-0650

logo

1.

Customer Information

Name:

Address:

City:

State:

 Zip:

Country:

Phone:

Email:

 

2.

Payment Method

Select one

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

Visa / MasterCard / American Express (circle one)

Credit Card Number:

Expiration Date:

/  Signature: _________________________

3.

Select Products

Buy 2 bottles of RivitaBust Get 1 bottle Free
(Three Month Supply )

$119.80

Buy 3 bottles of RivitaBust Get 2 bottles Free
(five Month Supply )

$179.85

Buy 5bottles of RivitaBust Get 4 bottles Free
(nine Month Supply )

$299.75

Single bottle of RivitaBust

  $59.95

Special Bonus Offer: Perfect Woman Firming & Toning Lotion

$24.95
b

Bonus Offer: Detoxify

$19.95

 

Subtotal:

$.

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

$.

Grand Total:

$.

4.

Mail Order Form to: (make the check payable to CTI)

Cosmeceutical Technologies

or Fax This Form to:

310-822-0650