Your Authorization code:

 

 

Ordering By Fax Instructions :


If you would like to send your credit card details to us by fax follow the instructions below:

Product :


Fax To :

(866) 820-0638 (Toll-Free)


Include The Following Information:

Billing Details :
(Exactly As It Appears On Your Credit Card)

Your Full Name, Street Address (Including Apartment Number If Present), City, State / Province, Zip / Postal Code And Country

Shipping Details:
(Only If Different From Your Billing Information)

Your Full Name, Street Address (Including Apartment Number If Present), City, State / Province, Zip / Postal Code And Country


Contact Information :

Your Phone Number And Your Email Address
Product Name :

Vimax Extender

Credit Card Details :

Credit Card Number
, Expiration Date and 3 Digit Security Code (The Last 3 Digits On The Back Of Your Credit Card)

Promotional Code :
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