ORDER FORM UNITED KINGDOM

Billing Information


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

Unit Price

Total

RC1 Ultramild Cleanser 4 oz bottle £22.00
RC2 Moisturizer 2 oz jar £31.50
RC3 Eye Cream 0.5 oz jar £31.00
RC4 Serum 1 oz bottle £42.00
RC5 Night Cream 1 oz jar £30.50
RC6 Facial Gel 2 oz pump £31.50
RC7 Strontium Calming Lotion 2 oz pump £32.75
RC10 Strontium Soothing Spray 4 oz spray pump £31.50
RC11 Sunscreen "30" 6 oz 6 oz tottle £36.50
RC11 Sunscreen "30" 4 oz 4 oz tottle £36.50
RC12 Concealer #2 0.35 oz Compact £28.00
RC13 Concealer #4 0.35 oz Compact £28.00
RC14 Concealer #6 0.35 oz Compact £28.00
RC15 Concealer #8 0.35 oz Compact £28.00
RC16 Concealer #10 0.35 oz Compact £28.00
RC17 Concealer #12 0.35 oz Compact £28.00

Sub-Total

Postage* £2.50 

Total

*Please note: 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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