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Fax Order

 

femestril fax order page

Fax Order Page

Please print this form, fill out all applicable information, and fax to:Pro Edge Labs Inc. Fax: 1-855-523-7275

Note:

There are 2 pages to this order form

 
SHIPPING INFORMATION
*** Please choose international shipping if you are outside the USA ***

Contact Person: ________________________________
Phone Number:________________________________
Email Address: ________________________________
Delivery/Mail Address: ________________________________ ___________________________________________


PAYMENT DETAILS

 

Please make all checks and money orders payable to: “Pro Edge Labs Inc.“Notice: All payments must be made in CDN (CDN $) only.PAYMENT OPTIONSWe accept the following forms of payment (CDN funds only):

  • credit/debit card
  • cashier’s checks
  • money orders

Note: We do not accept personal checks or COD’s.

NEXT – CONTINUE TO NEXT PAGE

 

 

Please select the credit card type used for this order:
MasterCard
Visa
American Express

 

If you are paying by credit card, please fill in the required information below:

Card Number: ______________________ ___________________
Card Expiration Date (MM/YY):

__ /__ CVV2 Number: ______ What is the CVV2 number?

Name as it appears on card: __________________________________
Credit Card Street Address: __________________________________
Credit Card City, State: __________________________________
Credit Card Country: __________________________________
Credit Card Zip/Country Code: __________________________________
Cardholder Signature: ________________________________________


*** NOTE *** We never automatically ship more boxes to you and bill your credit card unless you reorder.


*** Please choose international shipping if you are outside the USA. ***

Please select your shipping cost option below: NOTE – FREE SHIPPING ON ORDERS OF 4 OR MORE BOXES

FedEx
Ground 3-5 Days – $12.95 (USA) *Full tracking		 FedEx
Express 2-3 Days – $17.95 (USA) *Full tracking

USPS Global Priority Mail (INT)    5-7 Days –
$28.95  (No Tracking)

FedEx International Priority (INT)   3-5 Days –
$30.95  (Full Tracking)

 

QUANTITIES

 

Item Code Description Price in US$ Quantity (Please Specify)
001 1 box $49.95  ______
002 2 boxes $84.95  ______
003 3 boxes $119.95  ______
004 4 boxes $154.95  ______
005 5 boxes $189.95  ______
006 6 boxes $224.95  ______
009 9 boxes $298.95  ______

 

Please Fax This Form to 1-855-523-7275

 

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