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. 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 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

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


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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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