Order Form

To Mail, print form and mail To: Vital Skin Care 11402 Schuylkill Rd. Rockville, MD 20852 (make checks payable to Vital Skin Care):

A.  Personal Information First Name: Last Name: Street Address: City: State: Zip Code: E-Mail Address: Daytime Phone Number: Evening Phone Number:     B.  Your Order Products Price Quantity 1st Product: 2nd Product: 3rd Product: 4th Product: 5th Product:       C.  Total **Tax: 5% will be added for delivery in Maryland Shipping and Handling (see chart below): Order Subtotal Regular 2-5 days Up to $30.00 $5.00 $30.01-$75.00 $7.00 $75.01-$125.00 $9.00 $$125.01 and up $11.00 Total (not including tax. Tax subject to delivery in Maryland):   D.  Payment Check/Money Order Enclosed   Is your billing address different than the address above? Yes No If yes, enter your billing information below. Billing Street Address: City: State: Zip Code: Additional Comments or Special Instructions:   To Mail, print form and mail To: Vital Skin Care 11402 Schuylkill Rd. Rockville, MD 20852 (make checks payable to Vital Skin Care):

    

*Better Service and Better Prices - In A Home Based Business*