American Pharma Inc. Refresh Order Form
Simply Print and Mail OR Fax
Toll Free Fax:
1-888-777-0038
Must be 18 years or older to
purchase
Make Checks Payable to: Performance Marketing Ltd.
Please fill out the following form. Check the box next to the product
you wish to order, and then mark the quantity you wish to order.
|
Product |
Quantity |
Price |
Amount | ||
Refresh Acne Solutions -
12 Months |
$395.88 |
$ | |||
|
Refresh Acne Solutions -
6 Months |
$210.00 |
$ | |||
|
Refresh Acne Solutions -
5 Months |
$175.00 |
$ | |||
|
Refresh Acne Solutions -
4 Months |
$140.00 |
$ | |||
|
Refresh Acne
Solutions - 3 Months **BEST VALUE** |
$109.95 |
$ | |||
|
Refresh Acne
Solutions - 2 Months |
$
74.95 |
$ | |||
|
Refresh Acne
Solutions - 1Month |
$
39.99 |
$ | |||
 | |||||
|
All prices are in US Funds.
|
Sub-Total |
$ | |||
|
+
Shipping |
$ | ||||
|
+
Tax |
$ | ||||
|
Total
Order |
$ | ||||
|
Thank you for your Order. Additional
Information and/or |
Credit Card Number
(no spaces) Expiry Date________________________________ CVV2#____________________________________ Card Type_________________________________ Make
checks payable to: Name:_____________________________________ Address:___________________________________ __________________________________________ __________________________________________ Phone:____________________________________ E-Mail:____________________________________ |