Advanced Skin Care Product by MIRAKELLE: Order by Mail or Fax

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Billing Information

Payment Method:	Make Payable To:	Mail or Fax To:
Check [ ] Money Order [ ] Credit Card [ ]	Harbor Laboratories	Harbor Laboratories P.O. Box 145 Duxbury, MA 02331 FAX: 781-934-0967

Credit Card Orders:
Credit Card Type: [ ] VISA [ ] MasterCard
Account #: ______-______-______-______	Exp. Date: ___/___ (Month/Year)
Signature: ________________________________

MIRAKELLE Order Information

Advanced Restorative Skin Cream (2 oz.)
DISCOVER MIRAKELLE AT SPECIAL SAVINGS! $25.00 .................................. (Quantity X $25.00)

$ __________

SUBTOTAL:	..............................	$ __________
SALES TAX:	(MA Residents Add 6.25%)	$ __________
SHIPPING & HANDLING:	...................... (Add)	$ 5.95
TOTAL:	..............................	$ __________

Shipping Information

Name: ______________________________________

Address: ______________________________________

City: ______________________ State/Province: ________ Zip/Postal Code: ________

Phone: Area Code (____) Number _____-________

Thank You!
www.MIRAKELLE.com
Harbor Laboratories, Inc., Duxbury, MA
info@mirakelle.com

1-800-334-0667

The Product . The Company . What Users Say . Links

Modified: February 3, 2012

Webmaster: dawnsweb.net

Payment Method:

Make Payable To:

Mail or Fax To:

Credit Card Orders: