Order Form for Biolanyn skin cream ... type in >> then print
Please use a 'new' order form each time you order!

Sorry, we no longer accept payment by paper check.  Please use the eCheck option on our order page.

*Quantity purchases are not recommended for 'first time' buyers. Find out why?

Product
ID #

BSC-100
(Single jar)


Qty

  x $39.95 =

and
Quantity

BSC-100-4*
(4 Jar pack is $99.00)
Enter # of packs in Qty


Qty

  x $99.00 =

BSC-100-8*
(8 Jar pack is $173.00)
Enter # of packs in Qty


Qty

  x $173.00 =

The 12 jar package has been discontinued. Why?

Select your shipping destination and method  >>>     +
a. 48 USA continental states ... select 4-6 day USA Courier.
b. 10 Canadian provinces ... select 4-6 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. United Kingdom,  AU,  NZ ... select Air Mail.
f. ALL 'other' destinations except these ... select Air Mail Int.
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

Complete the following areas only if you are paying by 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.