We accept Mastercard and Visa. Please include your card type, card number, and expiration date on your order.
Secure on-line ordering with SSL will be available soon.
UPS Regular Delivery
Order Amount Shipping Charges Up to $35.00 $6.00 $35 - $64.99 $7.00 $65.00 - $94.99 $8.00 $95.00 - $124.99 $9.00 $125.00 and over $10.00
| Telephone: | 651-633-6368 |
| Mail: |
Recapture Skin Care 2721 Lincoln Dr Roseville, Minnesota 55113 |
Order Form
Bill To Ship To (if different)
Name: ___________________________ Name: ___________________________
Address: ________________________ Address: ________________________
City: ___________________________ City: ___________________________
State: ________ Zip: ____________ State: ________ Zip: ____________
Phone (Day): ____________________ Phone (Day): ____________________
Phone (Eve): ____________________ Phone (Eve): ____________________
Payment Method: Money Order or Certified Check: ______
Mastercard _____ Visa _____
Card #: ______________________________ Expiration Date: _____________
Product Description Qty Price Ext. Price
______________________________________ _______ ________ __________
______________________________________ _______ ________ __________
______________________________________ _______ ________ __________
______________________________________ _______ ________ __________
______________________________________ _______ ________ __________
______________________________________ _______ ________ __________
______________________________________ _______ ________ __________
Merchandise Total: __________
Minnesota Residents
add Sales Tax: __________
Shipping:
UPS Regular (from chart) __________
UPS 3-Day add $3.00 __________
UPS Overnight add $10.00 __________
Total: __________
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