hair loss and baldness natural treatment
hair loss Home
The Formula
Efficacy
News Media
hair loss baldness Medical Journals
Awards
Ingredients
Safety
Testimonials
Price
Our Guarantees
FAQ
Your Privacy
How to Order
Checkout Your shopping cart
Guest Book
Service Desk
Order Tracking
Guarantee Policy

ORDER FORM

Fill out and print this form. You can Fax it or mail it to us.

Order information
Product 101D
101F
101G
101 Shampoo
Shipping Method
Billing information
Your name(first, last)
Address (line 1) (No P. O. Box, please)
Address (line 2)
City
State/Province
ZIP or Postal Code
Country
Telephone (important! this is for delivery purpose)
E-mail
Payment Method
If you select Credit Credit card, please fill out the followings:
Card Type
Card holder's name
Card Number
Expires (month/year)
Instruction (optional)

FAX your order to
(604)322-6089 (Canada), (609) 799-2827 (USA/Europe) or +86(20)8758 0426 (Asia)

or mail your order to one of the following address:
Folica, Inc.
666 Plainsboro Road, Suite 1285
Plainsboro, NJ 08536, USA

Folica, Inc.
1081 East 63rd Avenue
Vancouver, B.C., V5X 2L2, Canada

Folica, Inc.
Suite 3919, Tian He Da Sha
#133-183 Ti Yu Xi Road
GuangZhou, China 510620

[ Home | Formula | Efficacy | Awards | News Media | Ingredients | Clinical Studies ]
[ Safety | Testimonials | Price | Order | FAQ | Guest Book | Privacy | Talk to Us ]

 

 

© 1995-99 Beijing Zhuangguang 101 Corp.
All copy and claims are valid in Germany, Canada, Japan, United Kingdom, China, Hong Kong, France, Italy and Australia
Product, packaging and shade offerings may vary by country.