Elite Group / KMA Apothecaries Mail Order Page
Simply fill out the form below
and mail with payment to:
Elite Group / KMA Apothecaries
1072 E. Newport Center Drive, Suite A
Deerfield Beach, FL 33442
Payment payable to "Elite Group"
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
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.