Uneet Co. Inc. Mail and Fax Order Form for
http://www.recapturehair.com    

Name
Address
City State
Zip Code Telephone number
Country Email address   Yes, send me future updates
Card number 
Expiration date 
Customer signature 

Items

QUANTITY

 COST EACH

TOTAL
Recapture Scalp Treatment, 8 oz.   $ 24.95  
Recapture Shampoo, 8 oz.   $ 9.95  
HomeoCare® Hair-x® Hair loss Relief , Set of 4 bottles, 75 pellets/ea.   $27.96  
SUB TOTAL      
NJ RESIDENTS ADD 7% SALES TAX      
SHIPPING AND HANDLING CONTINENTAL USA Only*  
$1-$40.00 $7.00
$40.01-$60.00 $8.95
$60.01-$80.00 $10.95
$80.01-$100.00 $12.95
$100.01 - up $14.95
 
*INTERNATIONAL SHIPPING AND HANDLING   $ 20.00  
TOTAL      
$15 RETURNED CHECK CHARGE.
Please make Checks and Money Orders payable to Uneet Co. in U.S. dollars drawn on a US bank only. Please allow 3 to 4 weeks for standard delivery. Every effort will be made to expedite and deliver orders as quickly as possible.

Credit Card Orders (Master card and Visa, American Express, Discover):
Note: The card billing address must be the same as the shipping address for verification purposes.

Orders may be faxed to:

1-888-262-3884 (toll free in the USA and Canada)
or 1-973-347-9220

International orders may be faxed to:

001-973-347-9220

Orders may be mailed to:

Uneet Co. Inc.
90-100 Route 206, PMB 231
Stanhope, NJ 07874
USA

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