BOOKLET ORDER FORM

Please complete this form and post, fax or email to: 
           Virtual Beauty Corporation Ltd
            P.O. Box 322 Whangaparaoa 0943 New Zealand
           info@virtualbeauty.co.nz

                  FAX NUMBERS
Australian customers: 0011 64 9 424 4459    U.S. customers: 011 64 9 424 4459
U.K. customers:  00 64 9 424 4459     South African Customers: 09 64 9 424 4459

 
 
Name:  
Clinic:  
Address:  
Suburb:  
City:   State:
Post code:   Country:
Contact: Ph: email

Booklets Req ........Skin Scanner Guide @ NZ$25 each = $
  ........Risk Assessment @ NZ$25 each = $
  ........Analysis with the SD202 @ NZ$25 each = $

Note: Pack & freight price is for up to 2 booklets
Pack & Freight Within N.Z.  $1.00 = $                       
Airmail To Australia  NZ$5.50 = $
Airmail To United States & Japan  NZ$7.95 = $
Airmail To Europe & U.K.  NZ$8.50 = $
Airmail To South Africa  NZ$10.50 =$
TOTAL NZ$
Payment method:     Cheque         Credit Card          Direct Debit
Credit card No:   Expiry:
Name on Card:  
EFT Debit Ref:   Date:
 

Please make cheques made payable to:  Virtual Beauty Corporation Ltd
EFT / Direct Debit bank details: National Bank of NZ,   Takapuna Branch, (06 0383) 
Account No 012108700     Swift Code: NBNZNZ22AKL
International Customers: 
Please email us for post and Freight Price if more than two booklets purchased 

info@virtualbeauty.co.nz