Special Request Order Form

Please fill out the below form. You will be contacted via email or phone with a price quote by one of our friendly staff.

First Name

Last Name

Email Address

Street Address

City

Province/State

Postal/Zip Code

Country

Telephone(with area code)

Fax Number

Payment Information
Preferred Shipping Method Canada Post Purolator

Preferred Payment Method Credit Card (VISA, MasterCard) Canadian Money Order Pick Up - Pay at the store


Comments

Plaque Off

$21.99

OxyLift Non Surgical Oxygenated Facelift System

$176.99

Rescue Remedy

$7.99