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Billing Information

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Harbor Laboratories

Harbor Laboratories
P.O. Box 145
Duxbury, MA 02331
FAX: 781-934-0967

Credit Card Orders:

Credit Card Type:   [ ] VISA    [ ] MasterCard    [ ] Discover

Account #: ______-______-______-______

  Exp. Date: ___/___ (Month/Year)

Signature: ________________________________


MIRAKELLE Order Information

Restorative Eye CremeGel (1.12 oz.)
DISCOVER MIRAKELLE AT SPECIAL SAVINGS!  $23.00  .................................. (Quantity X $23.00)

$ __________


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

$ __________

SUBTOTAL:

..............................

$ __________

SALES TAX:

.. (MA Residents Add 5%)

$ __________

SHIPPING & HANDLING:

...................... (Add)

$          4.95  

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

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Modified: October 6, 2008

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