Ascend Fax Order Form

Ascend Fax Order Form

Ascend For Women Order Form To order by mail or fax, please print and complete the following order form. Please include your personal check, money order or credit card information and signature. You may also order on the Internet or by calling our toll-free telephone number.
Web	http://www.dreamcastle.biz/		Phone	(800) 997-6287
Mail	Dreamcastle, Box 3778, Cerritos, CA 90703-3778, USA		Fax	(714) 995-5641

Please rush me ______ Ascend For Women - 30 capsules at $34.95/ea
Please rush me ______ Ascend For Women - 60 capsules at $49.95/ea
Shipping & Handling	+ $9.95
Add $3.50 for Priority Shipping
CA Residents add 9.00% for Tax
International order please add $4.50
TOTAL

Name

Phone No.

E-mail Address

Fax No.

Billing Address

Street
City
State
Postal Code
Country

Shipping Address (if different)

Street
City
State
Postal Code
Country

Credit Card Information
Card Type	Matercard Visa American Express Discover
Card Number
Name on Card
Expiration Date
Signature
How did you hear about us?
Repeat Customer Radio Friend Referral Fair/Convention Newspaper/Magazine Website/Search Engine specify_______________________________________________

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