prexil mail order page

Prexil Fax Order Page


Please print this form and fax to:

Pro Edge Labs Inc.
Fax: 1-855-523-7275

Note: There are 2 pages to this order form


 

SHIPPING INFORMATION

Contact Person: ________________________________  
Phone Number:________________________________
     
Email Address: ________________________________  
Delivery/Mail Address: ________________________________ ___________________________________________  
*** Please choose international shipping if you are outside the USA ***

 

PAYMENT DETAILS

Please make all checks and money orders payable to: "Pro Edge Labs Inc."
Notice: All payments must be made in USD (US $) only.

PAYMENT OPTIONS

  We accept the following forms of payment (U.S. funds only):

  • credit/debit card
  • cashier's checks
  • money orders
            Note: We do not accept personal checks or COD's.

 

 

NEXT - CONTINUE TO NEXT PAGE

 

 

 

 

 

If you are paying by credit card, please fill in the required information below:

Card Number: ______________________ ___________________
Card Expiration Date (MM/YY):
__ /__   CVV2 Number: ______   What is the CVV2 number?
Name as it appears on card: __________________________________
Credit Card Street Address: __________________________________
Credit Card City, State: __________________________________
Credit Card Country: __________________________________
Credit Card Zip/Country Code: __________________________________

Cardholder Signature:
________________________________________
Please select the credit card type used for this order:
MasterCard
Visa
American Express
*** NOTE *** We never automatically ship more boxes to you and bill your credit card unless you reorder.
 
*** Please choose international shipping if you are outside the USA. ***
Please select your shipping cost option below: NOTE - FREE SHIPPING ON ORDERS OF 4 OR MORE BOXES
FedEx Ground 3-5 Days - $12.95 (USA) *Full tracking FedEx Express 2-3 Days - $17.95 (USA) *Full tracking
USPS Global Priority Mail (INT)    5-7 Days - $28.95  (No Tracking)
FedEx International Priority (INT)   3-5 Days - $30.95  (Full Tracking)

 

QUANTITIES

Item Code Description Price in US$ Quantity (Please Specify)
001 1 box $68.95  
002 2 boxes $124.95  
003 3 boxes $174.95  
004 4 boxes $214.95  
005 5 boxes $244.95  
006 6 boxes $264.95  
012 12 boxes $398.95

Please Fax This Form to 1-855-523-7275