Elite Group / KMA Apothecaries Fax Order Page Simply fill out the form below and fax to (954) 418-6338 Contact Information Contact Person: Phone Number: Fax Number: Email Address: Delivery/Mail Address: Payment Details If you are paying by credit card please fill in the required information below: Name as on Card: CC# Street Address: CC# City: CC# State: CC# Zip Code CC# Country: Quantities Item Code Description Price $US   Qty (specify) VFIFS VISIFIRM™ Instant Firm Serum $39.95   VFICT VISIFIRM™ Intensive Cell Therapy $39.95   VFCOMBO VISIFIRM™ Instant Firm Serum plus VISIFIRM™ Intensive Cell Therapy $59.95   Shipping Please select your shipping cost below:   USA Shipment - $10.00   International Shipment - $20.00 Credit Card Details Please circle the credit card type being used: VISA   :   MasterCard   :   Discover Card Number: Expiration Date: CVV2 Number:   3 digit Card Verification Value If you decide to mail your payment, please use the following mail address: Elite Group / KMA Apothecaries 1072 E. Newport Center Drive, Suite A Deerfield Beach, FL 33442 Payment payable to "Elite Group" You will get results within the first month but it takes 3 to 4 months for optimum results. We never automatically ship more bottles to you and bill your credit card unless you reorder.