PefectWoman - Order Form

Mail / Fax Order Form
*Print this page, fill out all information, and send this form by mail or fax to:

Perfect Woman
165 Castilian Dr
Goleta, CA 93117

FAX: 805-681-8201

Customer Information

Name:
Address:

City:
State:	Zip:
Country:
Phone:
Email:

Payment Method

Select one
	Money Order / Cashiers Check (Payable to PerfectWoman.com in US$ only)
	Visa / MasterCard / American Express (circle one)
	Credit Card Number:
	Expiration Date:	/ Signature: _________________________

Select Products

	Buy 2 jars of Enlargement Creams Get 1 jar Free	$139.90
	Buy 3 jars of Enlargement Cream Get 2 jars Free	$209.85
	Buy 5 jars of Enlargement Cream Get 4 jars Free	$349.75
	Single jar of Perfect Woman Enlargement Cream	$69.95
	Single bottle of Perfect Woman Toning and Firming Lotion	$34.95
	Buy 2 bottles of Toning and Firming Lotion Get 1 bottle Free	$69.90
	Buy 3 bottlse of Toning and Firming Lotion Get 3 bottles Free	$104.85
	Detoxify - 1 bottle - One month supply	$29.95
	Bonus Offer - Toning & Firming Lotion - 1 bottle (price applies when any above item is purchased)	$29.95
	Subtotal:	$.
	Shipping (US orders $9.95, international orders $24.95)	$.
	Grand Total:	$.

Mail Order Form to:

Perfect Woman
165 Castilian Dr
Goleta, CA 93117

or Fax This Form to:

805-681-8201