Dermacure Order Page™
For faster delivery you may orderonline using your credit card or print thisform and fax it to (607) 936-8307. To place an order via "snail mail" printthis order form, fill it out, and mail it with your check, money orderor credit card information to:

SELECT PRODUCTS
Dept. GS
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 PIECEOF PAPER.

ClickHere To >>>ORDER ONLINE NOW !!!

You may also order with your credit card via our toll freeorder line at (800) 546-3962.   For inquiries call (607) 936-4617.

ClickHere>>>To Order Online With Complete Security and Confidentiality.


 

SizesQuantityCost Ea.Total
(One 3 ounce Jar)      Small$19.95
(One 6 ounce Jar)      Medium$29.95
(2 Jars = 9 ounces)     Large$39.95
(2 Jars = 12 ounces)   X-Large$47.95
                        Prices include postage inside the continental United States. All othersadd $9.00 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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