If you don't want to purchase over the internet, here's what to do: Print this page; fill it out neatly so we can read it and don't have to call you; be sure to sign it. Mail it to us with a MONEY ORDER made payable to EROGENICS, INC.

Mail to : Mail Order Department
Erogenics, Inc.    P.O. Box 2694   Lakeland, FL 33806   USA

Patented Feelbuck® ~ Be sure to check the line or just
circle the color you want!

Delivered Prices
within the USA.
  Delivered Prices
outside of the USA.

Clear = $140.00
Violet = $160.00
Ice Blue = $160.00
Cobalt Blue = $160.00
Solar Flair = $180.00
Red = $160.00
Transparent Black = $160.00

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Clear = $182.00
Violet = $202.00
Ice Blue = $202.00
Cobalt Blue = $202.00

Solar Flair = $222.00

Red = $202.00

Transparent Black = $202.00


Name:  ____________________________________________

Street Address:  ____________________________________    Apt #:  _____

City:  _______________________________    State:  ___    Zip Code:  _________

Country:  _______________Phone number with area code:  ___________________

or Email:  _________________________@_________________________________
 
TERMS AND CONDITIONS OF SALE:
  1. I am an adult as defined by governing law in my locale; 
  2. Any products, and/or information, and/or services obtained by me are legal materials as defined by the governing laws of my locale;
  3. I agree to defend and indemnify Erogenics, Inc., owner(s), employees, and contractors from claims, liabilities, losses, etc., arising from use or participation in the services, products, or information contained and/or obtained herewith.


          ________________                    __________________________________________________________
                    (date)                                                (your required signature)