Please print this form, then fillout your order and mail it to us.      
 
Product Name
**Unit Price
QTY
Total
3-Month Supply: 1X Shampoo: 3 bottles of 2 Oz. solution and 1X Shampoo
$74
    
6-Month Supply, 2X Shampoo: 6 bottles of 2 Oz. solution, and 2X 8 Oz. ProAnagen™ Shampoo
$132
    
12-Month Supply, 4X Shampoo: 12 bottles of 2 Oz. Solution and 4X 8 Oz. ProAnagen™ Shampoo
$242
    
1 X 8 OZ. ProAnagen Shampoo
$19.99
    
2 X 8 OZ. ProAnagen Shampoo
$38.78
    
3 X 8 OZ. ProAnagen Shampoo
$56.43
    
4 X 8 OZ. ProAnagen Shampoo
$72.98
    
1 X 8 OZ. ProAnagen™ Conditioner
$19.99
    
2 X 8 OZ. ProAnagen™ Conditioner
$38.78
    
3 X 8 OZ. ProAnagen™ Conditioner
$56.43
    
1 X 2 OZ. Shampoo Sample Please do not order sample, if ordering regular. Shampoo
$3.00
1
.
Sub Total
  
Colorado Residents: Please add 2.9% Sales Tax
  
   
 
Shipping & Handling Charges
Standard Shipping
Orders Less than $69
Orders $69 or More
 
U.S.
$8.50
$8.50
  
Canada/Mexico
$30
$30 (Up to 3 Lb./1.4 Kg.)
  
Europe
$30
$30 (Up to 3 Lb./1.4 Kg.)
  
Australia/New Zealand
$30
$30 (Up to 3 Lb./1.4 Kg.)
  
Please verify prices at www.proanagen.com
TOTAL
  
 
Customer Shipping Information
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Address 2  
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Zip Code  
Phone  
E-mail  
Please tell us how did
you heard about us:

Payment Methods Accepted:
At this time we only accept: money order, cashier's check or personal check (subject to funds clearing) for all mail orders.

Our Mailing Address:
ProAnagen™
P.O. Box 3248
Englewood, CO 80155-3248