Extagen Capsules Order Form | |
| Name: | |
| Shipping Address: | |
| Phone: | |
| E-Mail: | |
___ 1 Month Supply $74.95 ___ 6 Month Supply $226.74
U.S. Shipping
___ $6.95 5-7 business days ___ $9.95 5-7 business days
___ $11.95 3-5 business days ___ $14.95 3-5 business days
Canada, U.K., Australia
___ $12.95 1-4 weeks ___ $15.95 1-4 weeks
___ $22.95 6-10 business days ___ $25.95 6-10 business days
___ $29.95 3-5 business days ___ $32.95 3-5 business days
All other Countries
___ $15.95 1-4 weeks ___ $19.95 1-4 weeks
___ $27.95 6-10 business days ___ $30.95 6-10 business days
___ $36.95 3-5 business days ___ $39.95 3-5 business days
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| Total Amount Enclosed $________________ | |
| Let us know how you heard about us _________________________________________ | |
Mail To: J3 Labs
2122 W Lone Cactus Dr.
Suite # 1
Phoenix, AZ 85027
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