Date: Thu, 18 Dec 1997 07:28:57 GMT Server: Apache/1.2.4 Last-Modified: Thu, 13 Nov 1997 07:12:57 GMT ETag: "4200f-2b7c-346aa879" Content-Length: 11132 Accept-Ranges: bytes Connection: close Content-Type: text/html
Erox Corporation | |
4034 Clipper Court, Fremont CA 94538 | ORDER FORM |
For Fastest Ordering: | Order Date: ______________ |
Call (888) 77 REALM or Fax (510) 226-6431 | |
REALM Women Collection |
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Number of Units |
Item | Size | Price | Extended | FREE SHIPPING AND A BONUS GIFT IS YOURS WHEN YOU ORDER $50 OR MORE IN PRODUCTS
NEXT DAY, SECOND DAY, | |||
______ | Eau de Toilette | 1.7oz | 60.00 | ____________ | ||||
______ | Eau de Toilette | .15oz | 20.00 | ____________ | ||||
______ | Eau de Parfum | 15ml | 58.00 | ____________ | ||||
______ | Moisturizing Body Lotion | 6.8oz | 35.00 | ____________ | ||||
______ | Bath & Shower Gel | 6.8oz | 28.00 | ____________ | ||||
______ | Perfumed Body Cream | 6oz | 55.00 | ____________ | ||||
______ | Perfumed Body Talc | 3oz | 22.00 | ____________ | ||||
______ | Roulette EDT | .15oz | 28.00 | ____________ | ||||
______ | Refill for Roulette | .15oz | 17.00 | ____________ | ||||
______ | Weekender Gift Set | 36.00 | ____________ | |||||
______ | Value Set | 68.00 | ____________ | |||||
______ | Parfum Set | 45.00 | ____________ | |||||
______ | On The Go Traveler Set | 30.00 | ____________ | |||||
InnerREALM Collection for Women |
Shipping & Handling | |||||||
______ | Eau de Toilette | 2.49oz | 65.00 | ____________ | Qty. | Extended | ||
______ | Eau de Toilette | 1.33oz | 45.00 | ____________ | ||||
______ | Moisturizing Body Lotion | 6.8oz | 35.00 | ____________ | First Item @ 6.95 | ______ | ____________ | |
______ | Bath & Shower Gel | 6.8oz | 28.00 | ____________ | Second Item @ 3.95 | ______ | ____________ | |
______ | Roulette EDT | .15oz | 28.00 | ____________ | ||||
______ | Refill for Roulette | .15oz | 17.00 | ____________ | Next day $37.50 | ______ | ____________ | |
Second Day $24.50 | ______ | ____________ | ||||||
Hawaii & Alaska, Add $20.00 | ____________ | |||||||
REALM Men Collection |
SubTotal | ____________ | ||||||
______ | Eau de Cologne | 1.7oz | 60.00 | ____________ | ||||
______ | Eau de Cologne | .15oz | 20.00 | ____________ | Shipping & Handling is taxable: | |||
______ | After Shave Balm | 100ml | 30.00 | ____________ | AZ 6.3%, CA 8.25%, FL 7.5%, MI 6%, | |||
______ | Bath & Shower Gel | 6.8oz | 28.00 | ____________ | NJ 6%, NY 8.25%, OH 6.5%, TN 8.25%, | |||
______ | Antiperspirant Deodorant | 14.00 | ____________ | TX 8.25%, WA 7.0% | ||||
______ | Weekender Set | 36.00 | ____________ | |||||
______ | Value Set | 68.00 | ____________ | Tax | ____________ | |||
______ | On The Go Traveler Set | 30.00 | ____________ | Total Order | ____________ |
Billing & Shipping Information
Credit card Number: ______________________________________ Expiration Date: ___________________ Type: _____________ Name (on Credit Card): ___________________________________ Daytime Phone: ___________________________________________ Ship To Name: ____________________________________________________ Name: ____________________________________________________ Street: __________________________________________________ Street: __________________________________________________ City/State/Zip: __________________________________________ City/State/Zip: __________________________________________