Dermasal™ Fax in and Mail in Order Form
 
Return to http://www.dermasal.com/ homepage       
Call us with Questions 225-505-0943
 

Order Dermasal today and we will ship it directly to your door anywhere in the continental US EXPRESS via Priority Mail. We know that timing is important. Don't wait another minute. All orders are processed by New Tech Vitamins  PLEASE WRITE THIS DOWN FOR YOUR RECORDS

Fill in this order form and:

  • For credit cards: FAX it to us at 225-928-9902
  • For check and money orders: Mail in this order form along with your check or money order to:

    Make Checks or Money Orders Payable to:
    New Tech Vitamins
    7655 Airline Hwy
    Baton Rouge, LA 70814

    Customer Service #225-505-0943
    Fax #225-928-9902

Please select

______

Dermasal™ 1 month supply which includes 1 bottle of Dermasal Soothing Agent™, 1 bottle of Dermasal Protectant Gel™, and 1 jar of Dermasal Topical Solution™ for ONLY 82.95! 

______

Dermasal™ 2 month supply.  This includes 2 bottles of Dermasal Soothing Agent, 2 bottles of Dermasal Protectant Gel, and 2 jars of Dermasal Topical Solution for ONLY $118.00 

______

Dermasal™ 4 month supply that includes 4 bottles of Dermasal Soothing Agent, 4 bottles of Dermasal Protectant Gel, and 4 jars of Dermasal Topical Solution for ONLY $192.00

______

Dermasal™ 6 month supply that includes 6 bottles of Dermasal Soothing Agent, 6 bottles of Dermasal Protectant Gel, and 6 jars of Dermasal Topical Solution for ONLY $292.00
Shipping  
______
Standard Mail - USPS 3 -5 day delivery - $6.95
______
International Mail - USPS Global Priority Mail - 5-20 days - $19.95
Total  
______
Product Price + Shipping Fee
  • We do ship to APO/FPO addresses.
Your Information

First Name_________________________________Last Name ______________________________________

Shipping Address___________________________________________________________________________

City ____________________________________________ State ____________ Zip_____________________

Telephone (__________) ___________________________ Email____________________________________
MUST HAVE VALID CONTACT INFORMATION AND PHONE NUMBER
  
VISA  MASTERCARD    AMEX    DISCOVER     MONEY ORDER/CHECK*
(Please Circle One)

Card # ________________________________________________________________

CVV ______________
3 -4 digit code on back panel

Exp.____/_____

Name That Appears on Card:________________________________________________________
__

Driver's License Number (check orders) ________________________________ State ____________

  • All checks are held for 10 business days. Orders placed with a check will be held for 10 business days. Once 10 business days is complete, the order will be released and shipped.
  • All returned check will be charged a $25 USD return check fee.
  • Counter checks will not be accepted.
  • Check orders without email address, driver's license number, and driver's license state will not be processed.

       

 
Copyright 2004-2005 www.Dermasal.com - All Rights Reserved.