1pill.com Penis Enlargement Pills Mail Order Form
Simply Print and Mail OR Fax
Toll Free Fax: 1-888-777-0038
Must be 18 years or older to purchase
Make Checks Payable to: Performance Marketing Ltd.
Please fill out the following form. Check the box next to the product
you wish to order, and then mark the quantity you wish to order.
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Product
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Quantity
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Price
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Amount
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$ 250.00
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$ | |||
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$ 200.00
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$ | ||||
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$ 159.95
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$ | ||||
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$ 109.95
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$ | |||
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$ 59.99
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$ | |||
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All prices are in US Funds.
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Sub-Total
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$ | |||
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+ Shipping
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$ | ||||
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+ Tax
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$ | ||||
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Total Order
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$ | ||||
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Thank
you for your Order. Additional
Information and/or |
Credit Card Number
(no spaces) Expiry Date_________________________________ CVV2#_____________________________________ Card Type__________________________________
Make
checks payable to:
Name:_____________________________________ Address:___________________________________ __________________________________________ __________________________________________ Phone:____________________________________ E-Mail:____________________________________
Ref. # |