Rogaine and Minoxidil Order Form

Cyber Star Services
Secure Order Form for Rogaine and Minoxidil
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HAIR REGROWTH PRODUCTS

Select the item(s) you wish to order.
All prices are in US Dollars.

  Rogaine Foam 5% four month supply: $64.99
  Rogaine Foam 5% eight month supply: $126.99
  click here to clear selection above

  Minoxidil 5% for Men three month supply: $20.99
  Minoxidil 5% for Men six month supply: $38.99
  click here to clear selection above

Rogaine for Women 2%: OUT OF STOCK

  Generic Minoxidil 2% four month supply: $27.99
  Generic Minoxidil 2% eight month supply: $51.99
  click here to clear selection above

Shipping and handling fees for U.S.A. orders are $8.00 for the 3 and 4 month sizes and $11.00 for the 6 and 8 month sizes. U.S.A. shipping includes Guam, Puerto Rico, and U.S. Virgin Islands. Shipping and handling fees for all other destinations outside of the U.S.A. are $18.00 for the 3 and 4 month sizes and $25.00 for the 6 and 8 month sizes.

Expect delivery within 4 to 6 business days from the date of your order (U.S.A. orders). Mail orders and those shipped outside of the U.S.A. will take longer. We ship to Post Office Boxes. California residents will be charged sales tax.

Customer Information Enter the address where you receive your credit card statement.

Name
Address 1
Address 2
City
State
or Province
Zip/Postal Code
Country
Telephone
E-mail

Shipping Information click here if it is the same as your Customer information.

Name
Address 1
Address 2
City
State
or Province
Zip/Postal Code
Country
Telephone
E-mail

Payment Information We accept American Express, VISA, MasterCard, and Discover.

Credit Card Type
Card Number
Expiration Date	.Month (MM)...Year (YYYY).
Cardholder Name (as printed on the card)

Please review your entries above before submitting the order.

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