Fax order form: Fax to 012 361 0061

If you wish to order via fax:

  • Please print out this page
  • Fill in your order and your credit card details, or pay by EFT and fax us the proof of payment. Our bank details....
  • Fax it to our offices.

HOME PAGE

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 190.00    
Postage / Courier

R 35.00

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. See more information on South African delivery...

  Total R