Original Rejuvenex Products
To FAX ORDER: Please print this order form, fill out information and fax to (212) 557-5063.
To ORDER ONLINE: Click on Shopping Cart Buttons.
For any questions call (212) 983-6383.

MONDO-MER, Inc. Suite 114 • 333 East 43rd Street, New York, NY 10017
Phone (212) 983-6383 • Fax (212) 557-5063

Date: _________________ Phone: _____________________________

Name: ________________________________________________________________________

Address:__________________________________Town_____________State_______Zip ______

Payment by check or credit card:

Money Order or Check #_____________________ Made out to Mondo-Mer, Inc.

Credit Card Info-Circle One-Visa/Mastercard/Amex: _________________________ Ex _____/_____

Product

Size

Price

Qty

 

Total

Shopping
Cart

Ultra Hi-Power Capsules

Buy 2 or more and SAVE

180

$62 ea
$58 ea

________ ________

 

 

 

     
   

 

  Sub Total ________  
        Shipping ________  
        Total ________  

Shipping and Handling Charges

UPS Flat Rate $15.00.

Thank You For Your Purchase!
We will contact you to confirm your order.
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