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

Quantum Hydrox

$18.99

Urist Wrinkle & Frown Line Cream

$48.99

Udo's Oil 369 Blend

$10.99