Please fill in the order information below, and let us know how to contact you.

Select the type of card you will be using:

* Credit Card Number

  "Do not include spaces or dashes"

* Expiration Date 

  ie. mm/dd/yyyy
     
Package 1 (MaxAir™ Nasal Dilators; Package includes 2 X-Sm, 4 Sm and 2 Lrg) QTY.   @ $9.95 ea.
     
Package 2 (Cellulose-Skin tone 6 Small) QTY.   @ $8.95 ea.  
     
Package 3 (Cellulose/Carbon-Clear 6 X-Small) QTY.   @ $9.45 ea.  
     
Package 4 (Cellulose/Carbon-Skin tone 6 X-Small) QTY.   @ $9.95 ea.  
     
Package 5 (Cellulose/Carbon-Clear 6 Small) QTY.   @ $9.45 ea.  
     
Package 6 (Cellulose/Carbon-Skin tone 6 Small) QTY.   @ $9.95 ea.  
     
Package 7 (Cellulose/Carbon-Clear 6 Large) QTY.   @ $9.45 ea.  
     
Package 8 (Cellulose/Carbon-Skin tone 6 Large) QTY.   @ $9.95 ea.  
     
Package 9 (Sizing Package XS, Sm, Lg) QTY.   @ $2.95 ea.  
       

* Name
Title
Company
* Address
* City
* State
* Zip
* E-mail
* Phone (i.e. 321-453-3848)

Please have a salesperson contact me

* Designates a required entry

Note: If you do not receive an e-mail confirming your order within 48 hours of your submission, please resubmit your order. Please allow 4 to 7 days for delivery.

**Add $ 3.50 for Shipping and Handling (up to six packages) within the U.S. Additional shipping may apply for orders outside of the United States. An additional 6% sales tax will be added for all Florida residence.

 

We are currently seeking Distributors World Wide.

If interested please contact us or let us know by going to our Feedback page.