SAMPLE KIT ORDER FORM
UNITED KINGDOM

 


Customer Name 		 

Personal cheques are not accepted, but Postal Orders may be made payable to:
Rosacea Care
And mailed to:
Rosacea Care
121 Cambridge Road
Wimpole, Nr. Royston
Herts, SG8 5QB

Address

City                                             County              Post Code

Phone                                           E-mail

If you are paying by credit card, please fill in the following:
O MasterCard     O Visa     O Maestro     O Solo     O Switch

Exact Name on Card:      Issue Number: 

Credit Card Number:      Expiration Date: 

3 digit security number on the signature strip on the reverse of card: 



QUANTITY ITEM# DESCRIPTION SIZE PRICE TOTAL
RC8

SPECIAL   Sample Kit:
Cleanser, Moisturizer, Facial Gel, Serum,
Strontium Calming Lotion

5 items £15.00
RC9

Eye Cream Sample

1 item £3.00
RC12

Sunscreen "30" Sample

1 item £3.00
RC19

Night Cream Sample

1 item £3.00
RC18

Concealer Sample Box

6 shades

£12.00
Postage*
£2.50
Total

*There are no postal charges for 1 sample kit/or 1 sample box,
but if more than 1 kit/box ordered together then postage is £2.50.
Express delivery is avalable for £5.70.

To order by mail in the United Kingdom, print out the order form
You may also fax a filled-out form to 0122-320-8507
To order by phone call 0122-320-8882

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