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Fax Order Page
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Fill out the form below & fax to:
(702) 921-6366
For Office Use Only:
None
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SHIPPING INFORMATION
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Contact Person:
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Phone Number:
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Email Address:
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Delivery/Mail Address:
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PAYMENT DETAILS
Please make all checks and money orders payable to:
"DM Contact Management Ltd"
Notice: All payments must be made in USD (US $) only.
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If you are paying by credit card, please fill in the required information below:
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Card Number:
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Card Expiration Date (MM/YY):
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Name as it appears on card:
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Credit Card Street Address:
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Credit Card City, State:
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Credit Card Country:
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Credit Card Zip/Country Code:
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Cardholder Signature:
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Please select the credit card type used for this order:
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 MasterCard
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Visa
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American Express
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Eurocard
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If you decide to mail your payment, please use the following mailing address:
DM Contact Management Ltd
2414 4th Avenue
Greeley, Colorado, USA
80631
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*** NOTE ***
We never automatically ship more devices to you and bill your credit card unless you reorder.
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SHIPPING COST
*** Please choose international shipping (INT) if you are outside the USA. ***
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UPS 2-3 Day - $16.99
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UPS Overnight - $28.99
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UPS 3-5 Day - $14.99
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Fedex Rush 2-5 Days (INT) - $35.00
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DHL Rush 3-6 Days (INT) - $22.99
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| Item Code | Description | Price in US$ | Quantity (Please Specify) |
| 001 |
Deluxe ProExtender System |
$429.95 / system |
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| 002 |
Original ProExtender System |
$329.95 / system |
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| 003 |
Deluxe ProExtender Device |
$399.95 / device |
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| 004 |
Original ProExtender Device |
$299.95 / device |
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| Special Offer Product |
Regular Price in US$ |
Special Price in US$ |
Price Savings |
Quantity (Please Specify) |
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VigRX Oil
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$49.95 / bottle
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$39.95 / bottle
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20%
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