Order Form Oxylabs
		Order Form Submit this order form and payment to office@oxylabs.co.za Please complete all the fields in the form. Customer Details Name Street 1 Street 2 City Province/State Zip/Postal Code Country USA Albania Algeria Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Barbuda Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Corsica Costa Rica Cote D'Ivoire Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia, Republic of Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Republic of Kuwait Kyrgystan Laos Latvia Lebanon Lesotho Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Madeira Islands Malawi Malaysia Maldives Mali Malta Manua Islands Martinique Mauritania Mauritius Mexico Moldova Monaco Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Christopher Samoa, American San Marino Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St Christopher & Nevis St Helena St Kitts St Lucia St Pierre & Miquelon St Vincent & Grenadines Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tristan De Cunha Tunisia Turkey Turkmenistan Turks and Caicos Is Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican city Venezuela Vietnam Wallis & Futuna Islands Western Samoa Yemen, Republic of Zaire Zambia Zimbabwe Contact No Email Address Upon receipt of order, banking details will be forwarded to you. Your order will only be processed once proof of payment has been received. Please email your proof of payment together with the order to orders@oxylabs.co.za. Please allow 2 working days for delivery in South Africa and between 10-14 days for international orders. Any order queries please e-mail us at : orders@oxylabs.co.za Exoderm Products Products Description Unit Price Exoderm Solution™ 100 ml Bottle R 270.00 Exoderm Lotion™ 100 ml Bottle R 190.00 Exoderm Shampoo™ 200 ml Bottle R 200.00 Oxytherapy™ 100 ml Bottle R 400.00   N.B. For Local and International Orders The quoted Postage Costs are limited to a MAXIMUM ORDER of 4 items. Should you wish to order more than four products please contact us to verify postage costs. N.B. For International Orders Post Office - R 99.00 Speed Service - R 120.00

 

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