Fax Order Page Fill out the form below & fax to: (702) 921-6366 For Office Use Only: SHIPPING INFORMATION Contact Person:   Phone Number:   Fax:   Email Address:   Delivery/Mail Address:       PAYMENT DETAILS Please make all check and money order payable to: "DM Contact Management Ltd" Notice: All payments must be made in USD (US $) only. If you are paying by credit card, please fill in the required information below: Card Number:   Card Expiration Date (MM/YY):   /   CVV2 Number:   Name as it appears on card:   Credit Card Street Address:   Credit Card City, State:   Credit Card Country:   Credit Card Zip/Country Code:   Cardholder Signature:   Please select the credit card type used for this order: MasterCard Visa American Express Eurocard If you decide to mail your payment, please use the following mailing address: DM Contact Management Ltd 2414 4th Avenue Greeley, Colorado, USA 80631 *** NOTE *** We never automatically ship more bottles to you and bill your credit card unless you reorder. SHIPPING COST *** Please choose international shipping (INT) if you are outside the USA. *** UPS Domestic 3-4 days - $12.99 UPS 2 Day - $16.99 UPS Overnight - $28.99 Fedex Express International - $35.00 DHL International 1-4 days - $22.99 QUANTITIES Item Code Description Price in US$ Quantity (Please Specify) 001 1 bottle 110 AED   002 2 bottles 155 AED   003 3 bottles 198 AED   004 Additional bottles 43.80 AED / bottle   Receive 1 FREE bonus gift for orders of 4 bottles or more! Select your bonus gift below. Girls Gone Crazy Video* (1 FREE video) Nexus Pheromones (1 FREE bottle) Semenax (1 FREE bottle) Special Offer Product Regular Price in US$ Special Price in US$ Price Savings Quantity (Please Specify) VigRX Oil $49.95 / bottle $39.95 / bottle 20%   * Due to Customs Regulations the Bonus Video is not available outside of North America *