VIBRANT SKIN, INC. VITASAGE - ALL NATURAL SKIN CARE PRODUCTS MAIL ORDER FORM 2 oz. tube of Vitasage Facial Massage Cream and Vitamin Moisturizing Treatment qty_____x $9.95 each...total $_____ All Natural Ingredients: vitamin A, vitamin C, vitamin E, almond oil, olive oil, glycerin, lanolin, honey, and essence of chamomile 4 oz. tube of Vitasage Sugar Scrub Exfoliant qty_____x $9.95 each...total $_____ All Natural Ingredients: Sugar, vitamin E, vitamin A, vitamin C, almond oil, olive oil, glycerin, lanolin, honey, and essence of chamomile 3 oz. bar of Vitasage Moisturizing Soap for Face and Body qty_____x $4.95 each...total $_____ All Natural Ingredients: 100% food grade saponified coconut and olive oil with the addition of lanolin, almond oil, vitamin E, Vitamin A, olive oil, glycerin, honey, essence of chamomile Shipping and handling is $7.00 for the first item, $1.00 for each additional item. Product Total $_______ Shipping Total $_______ Tax $_______ (Georgia residents please add applicable sales tax) Grand Total $_________ Your Name: ____________________________________________________ Address: _______________________________________________________ City: _______________________________State: _________Zip: _________ Telephone No.: _____________________e-Mail: ______________________ Ship To: Name: _________________________________________________ Address: _______________________________________________________ City: _______________________________State: _________Zip: _________ SPECIAL INSTRUCTIONS: __________________________________________________________________________________ Method of Payment: Check Money Order Credit Card E-mail / Order Page / Facial Instructions / Dry Skin Solutions / Ingredients