Online Shopping Form
Please complete your Details Accurately
Products
Limited Time Offer - DISCOUNTS!!
$30 or more 5% discount - $50 or more: 10% discount - $75 or more 15% discount - $100 or more 20% discount
Code
Description
Size
Units Required.
Price $US
AV001
Avenir Herbal hair tonic
100ml
$10.98
AV002
Avenir Hair Tablet Formula
60 Tabs
$11.98
AV003
Avenir Shampoo Concentrate Additive
50ml
$3.95
Shipping Costs
Billing Details
The box below shows products ordered - the boxes to the right indicate Sub total, Discounts and the Final Purchase Total in Dollars.
Subtotal US $
Discount %
Total US $
Personal Details
Full Name:
Mr.
Mrs.
Miss.
Ms.
Prof.
Dr.
Sir.
E-mail:
Shipping Details:
Please note that P.O. Box addresses will not be accepted for deliveries unless your credit card CVV number is filled in under credit card details!! The same applies to orders with delivery addresses that differ to the billing address
in most cases of P.O. Box delivery request we will contact you telephonically
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
Credit Card Details:
Card Holders Name:
As it appears on card
Card Type:
Choose Card Type
American Express
Master Card
Visa
American Express - Master Card - Visa
Credit Card Number:
Type number without spaces or hyphens
CVV number*
Last 3 or 4 digits of number on back of Credit Card
*Required for P.O. Box delivery orders only
Use the text box below to enter either comments or instructions or enter your personal address details if they differ from the shipping to address entered above under "Shipping Details"
enter your text here
Order
Read Our Shipping Conditions!
Currency Converter