Mail Order Form Canada
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Note: Prices on this form
are listed in Canadian Dollars.
We will send you an email confirmation as soon as your order ships.

Ship To Information:

Name:

Address 1:
Address 2:

City:
Province:
Postal Code:
Country:

Telephone:

Email address:


Yahoo Google Banner
TV Doctor Magazine
Radio Word of mouth Email
Other: ___________________________

 

Order Information.

I would like to order:

(price includes $7.95 CAD shipping)

1 bottle of Vilantae...........$57.90 CAD

2 bottles of Vilantae..........$107.85 CAD

3 bottles of Vilantae.........$157.80 CAD

1 bottle of Vilantae
and 1 COLD FUSION acne treatment
.....................................$97.85 CAD

Other: Please specify and add total below:



other
(please write below)




(please write in and calculate total if ordering more than 3 bottles, or if you would like to order a different product. Shipping is a flat $7.95 CAD regardless of order size. For other products listed in US Dollars, please use the online
currency converter at: http://www.xe.com/ucc/

 

We will send you an email confirmation as soon as your order ships.

Please print this page and mail with check or money order to:

Evolution-X
2700 South Roan Street #440
Johnson City, TN 37601
United States
Checks should be written out to Evolution-X. Delivery generally takes 5-9 days from the time we receive your order form.