MAIL ORDER FORM

For fastest ordering call toll free 1-877-624-6211
(Make checks and money orders payable to Magna RX Inc.)

Mail this form to:

- Magna Rx Inc.
- Po Box 6879
- Thousand Oaks, CA 91359 U.S.

BUY ANY ONE & GET THE OTHER TWO FREE!
GET: MAGNA-RXTRA+ (30 days), original MAGNA-RX+ (30 days) and
MAGNA-RX+ Topical Lotion (30 days) . . . . . . . . . SAVE $139.90! Only $59.95
DOUBLE YOUR ORDER FOR ONLY $40 MORE!
GET: MAGNA-RXTRA+ (60 days), original MAGNA-RX+ (60 days) and
MAGNA-RX+ Topical Lotion (60 days) . . . . . . . . . SAVE $299.75! Only $99.95
TRIPLE YOUR ORDER FOR ONLY $30 MORE!
GET: MAGNA-RXTRA+ (90 days), original MAGNA-RX+ (90 days) and
MAGNA-RX+ Topical Lotion (90 days) . . . . . . . . . SAVE $469.60! Only $129.95
Total Purchase...................................................................................................$________

CA Residents ADD Sales Tax.............................................................................$________

Shipping & Handling...........................(usually delivered within 7-10 days)..............$19.95

Shipping & Handling...........................(Non U.S. Orders)......................................$ 33.95

Total Enclosed/Charged......................................................................................$________
Payment: Check Money Order

Charge It: VISA MC AMEX DISC
Exp. Date__________________/____________________
Account Number
3 - Digit Security Code on the back of card or Amex 4 Digit on front___________________________________


Signature:____________________________________________________________________________________


Name (print):__________________________________________________________________________________


Address:_____________________________________________________________________________________


City:____________________________________________State:__________________Zip:___________________


Phone:___(____________)______________________________________________________________________


Email Address:_______________________________________________________________________________

Finding Your 3 or 4 digit security code Code
   
Amex Requirements
Card Identification # REQUIRED
4 digit, non-embossed number printed above your account number on the face of your card. This number is recorded as an additional security precaution. 		Visa Requirements
Card Identification #
3-digit, non-embossed number printed on the signature panel on the back of the card immediately following the Visa card account number. This number is recorded as an additional security precaution. 		MasterCard Requirements
Card Identification #
3-digit, non-embossed number printed on the signature panel on the back of the card.. This number is recorded as an additional security precaution.

© 2005-09 Magna RX Inc. MAGNA-RX+® is a Registered Trademark. All Rights Reserved. These offers or any offers from Magna RX Inc. are not valid in the state of Arizona or anywhere prohibited by law. Individual results may vary. Individuals and testimonials shown on the website are paid models and not necessarily Magna RX Inc. product users. Trademarks, service marks, logos, and/or domain names (including, without limitation, the individual names of products and companies) are the property of their respective owners, have no association with and do not make any endorsement of Magna RX Inc. Products. The statements on this website have not been reviewed by the Food and Drug Administration. This product or any Magna RX Inc. product is not intended to diagnose, treat, cure or prevent any disease.