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F.A.Q.

REFILLS

RECONSULTS

CONTACT INFO
 

TERMS & PRIVACY


Refills

 Name
 
Refill/Recon:
 
First Name:
 
Last Name:
 
Date of Birth:
 
 Contact
 
 Street:
 
                   City:
 
                  State:
 
           Zip Code:
 
 
               E-mail:
 
     Home Phone: eg: xxx-xxx-xxxx
 
     Work Phone: eg: xxx-xxx-xxxx 
 
 Comments Comments :  ALL member information remains the same as the initial information.  If you have any changes in Billing, Delivery, ETC please note them here in the comments section.


Payment Options - COD or CREDIT CARD

Shipping $30 plus $14 COD

Saturday Shipping Additional $14 


COD (check here for COD): 
   
   
Name as it appears on Card:  
Credit Card Number:  
Security Code: (usually 3 or 4 digits found on back of card)  
Expiration Date (eg: xx-xxxx):  
Billing Address:      
Street:  
City:  
State:  
ZipCode:  
Shipping Address:      
Street:  
City:  
State:  
ZipCode:  
       

When paying with check or money order a customer service representative will inform you as to whom to make payable to.