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 6% 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:

1-973-347-0200

International orders may be faxed to:

001-973-347-0200

Orders may be mailed to:

Uneet Co. Inc.
275 RT 10 East, Ste 220-405
Succasunna, NJ 07876
USA

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