Order Form

Please use this form to place your order.
To order by email, click submit at the bottom of this form.
(Please, for your own protection, NO Credit Card orders by email at this time.
- Secure Server Not Available at this time)
To fax or mail your order - print this page, complete form
and send to:

FAX:       1-508-862-2620

Mail to: Val Collias
              461 Main Street
              Hyannis, MA 02601

Tele:      1- 508-771-4746
or
Toll free 1-888-549-4748 (USA only)

Please select the products you would like::

QTY

PRICE

SUBTOTAL

MIRACLE II SOAP
$ 16.00

MIRACLE II NEUTRALIZER
$ 16.00

MIRACLE II NEUTRALIZER GEL
$ 16.00

MIRACLE II SKIN MOISTURIZER
$ 16.00

MIRACLE II MOISTURIZING SOAP
$ 16.00

MIRACLE II DEODORANT STONE
$ 12.00

M-II LAUNDRY BALL
$ 52.00

GAL. SOAP
$ 67.00

GAL. NEUTRALIZER
$ 67.00

GAL. GEL
$ 180.00

GAL. MOISTURIZER
$ 180.00

ORDER TOTAL

SHIPPING

TOTAL

BILLING*

Credit card

Cardholder name

Card number

Exp. date

SHIPPING ADDRESS

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Please provide the following billing/contact information:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Phone

FAX

E-mail

URL

*Credit Card orders by FAX or mail only at this time.