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If you wish to order via fax:
- Please print out this page
- Fill in your order and your credit card details (for direct money transfer info, click here)
- Fax it to our offices.
Our fax number in Pretoria is 012 361 0061
To return to our Instant Eye Lift Gel page, click here, and to go to our home page, click here.
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PLEASE NOTE – We charge R 30.00 for delivery anywhere in South Africa and our minimum order quantity is R 150.00 per order. |
| Name
and surname |
|
| Credit
card type |
Visa
/ MasterCard / Amex / Diners (Circle the type) |
| Card
number |
|
| CCV
number (3 digit number on the back of
your card on the signature strip) |
(If you are paying by direct
transfer into the ABSA account, please fax proof of payment)
|
| Expiry
date |
Month
(............)
Year (............) |
| E-mail
address |
|
| Telephone
number |
|
Full
street or postal address
(including Province, postal code. |
line
1 |
| line
2 |
| line
3 |
| Signature as on card:
..................................... |
Province: |
| Postal code: |
| (Postal code is also used for courier parcels, as courier companies use the code to sort their parcels) |
| Description |
|
|
Quantity |
Total |
| Instant
Eye Lift Gel |
R |
170.00 |
|
|
| Postage
/ Courier |
|
|
|
30.00 |
|
If we are supplied with a
street address your parcel will be sent by courier. If we are supplied with a postal box address, your parcel will be sent via the Post Office Speed Courier Services to the Post Office counter. |
|
|
Total |
R |
|