Ascend Fax Order Form

Dreamcastle Products Order Form
To order by mail or fax, please print and complete the following order form.  Please include your personal check, money order or credit card information and signature.  You may also order on the Internet or by calling our toll-free telephone number.

Web
http://www.dreamcastle.com/products
 
Phone
(800) 997-6287
Mail
Dreamcastle, Box 3778, Cerritos, CA 90703-3778, USA
 
Fax

Please rush me ______ Ascend For Men - 60 Capsules at $49.95/ea
 
Please rush me ______ Ascend For Women - 60 Capsules at $49.95/ea
 
Shipping & Handling + $0.00
Add $0.00 for Priority Shipping  
CA Residents add 9.00% for Tax  
International order please add $0.00  
TOTAL  

Name
 
 
Phone No.
 
E-mail Address
 
 
Fax No.
 

Billing Address
Street
 
City
 
State
 
Postal Code
 
Country
 
 
Shipping Address (if different)
Street
 
City
 
State
 
Postal Code
 
Country
 

Credit Card Information
Card Type
Matercard Visa American Express Discover
Card Number
 
Name on Card
 
Expiration Date
 
Signature
 

How did you hear about us?

Repeat Customer Radio Friend Referral Fair/Convention Newspaper/Magazine
Website/Search Engine specify_______________________________________________