Order Form for Biolanyn skin cream ... type in >> then print
Please use a 'new' order form each time you order!
* Quantity purchases are not recommended for 'first time' buyers. Find out why?

Product
ID #

7101
(Single jar)


Qty

  x $39.95 =

and
Quantity

7102*
(2 Jar pack is $68)


Qty

  x $68 =

(Enter # of
packs in Qty)

7104*
(4 Jar pack is $120)


Qty

  x $120 =

7108*
(8 Jar pack is $192)


Qty

  x $192 =

Select your shipping destination and method  >>>     +
a. 48 USA continental states ... select 3-6 day USA Courier
b. 10 Canadian provinces ... select 3-6 day CAN Courier
c. 'Next Morning' Courier [ONLY available for the 10 Canadian provinces. Guaranteed for orders received by 9 am EST previous business day.] ... select CAN EXPRESS
d. Alaska, Hawaii, Puerto Rico ... select 1-2 day Air Courier
e. ALL 'other' destinations except these ... select Air Mail - allow a minimum of six (6) weeks delivery time to most destinations.  We no longer ship to PO Boxes

--------------------

Sub-total   

Add tax for Canadian Ship To addresses only.
Click here for % amount to add to Sub-total.

             +

--------------------

Total $US

Name:

Email:


Please double check the spelling of your email address - required for shipment
Company:

optional
Address:

City:

State (Prov):

Postal code:

Country:

Phone:

Phone number is required for shipment

Payment options:  Money-order or credit card
Credit Card #:

Only Visa & MasterCard accepted
Expiry Date:

Signature: _________________________
I authorize Attogram Corp. to charge my credit card for the amount entered in the "Total $US" field above, for the purchase (and shipment) of the Biolanyn skin cream.  Please print this form, sign it ... then fax or mail to Attogram Corp . Do not use this form to send your credit card information by email.