Mail Order Form

Please fill out this form completely, then click on the "Print Form" button below. 

Sign the completed form and mail it to us.

If you have any questions please Contact Us

(Please Note, this form will NOT send information over the internet)

Purchaser Information

Name:

  
Company:  

Address:

  
City:

 
State:

  or Province  

Zip/Postal Code:  
Country:
E-Mail Address:  

What product are you ordering?

Please choose Shipping Option

Two DermaTend™ Advanced        $99.95

 Domestic $11.95 International $18.95

DermaTend™ Advanced  $69.95

 Domestic $7.95 International $14.95

Original DermaTend™       $39.95

 Domestic $5.95 International $12.95

DermaTend™ Healing Balm $14.95

 Domestic  $3.95 International $10.95

Tax (Nevada Residents Only) 7.725%)

Total

Comments/Special Instructions (non delivery)

 

 
 
Signature:___________________________________Date:_________________
 
Print Name: __________________________________________
 
 Please fill out this form completely, then click on the "Print Form" button.
Sign the completed order form and and mail it to us at:
 
Solace International, Inc.
1055 W. Moana Ln, Ste.202
Reno, NV, 89509
 
MAKE CHECKS OUT TO: SOLACE INTERNATIONAL, INC.

 


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