MagnaRXTRA - Mail Order Form

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

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.