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$50.00 minimum order required if using a credit card

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e-mail *

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#
PRODUCT
SIZE

$/UNIT

QTY.

AMOUNT

1
Rejuvi "a" Night Gel
1.5 oz.

2
Rejuvi "a" Renewal Complex
1 oz.

3
Rejuvi "a" Retinyl Serum
1 oz.

4
Rejuvi "a" Asta Enhancing Serum
0.5 oz.

5
Rejuvi "b" Skin Moisturizer
1.76 oz

6
Rejuvi "b" Moisturizer Lotion
3.4 oz.

7
Rejuvi "c" Skin Care Formula
1 oz.

8
Rejuvi "d" Clearing Gel
10 ml.

9
Rejuvi "e" Eyebrow Revitalizer
9 ml.

10
Rejvui "e" Eyelash Revitalizer
9 ml.

11
Rejuvi "f" Facial Wash
7.04 oz.

12
Rejuvi "g" AHA Cream
1.76 oz.

13
Rejuvi "g" AHA Cream (for sensitive skin)
1.76 oz.

14
Rejuvi "g" AHA Serum
1 oz.

15
Rejuvi "h" Super Soothing Cream
0.35 oz.

16
Rejuvi "h" Super Soothing Lotion
3.4 oz.

17
Rejuvi "h" Skin Healing Gel
5.1 oz.

18
Rejuvi "i" Eye Repair Gel
1 oz.

19
Rejuvi "i" Eye Repair Cream
2 oz

20
Rejvui "j" Shower Cream
12 oz

21
Rejuvi "k" Facial Cleanser
7.04 oz.

22
Rejuvi "L" Body Lotion
8.38 oz.

23
Rejuvi "m" Massage Oil
4 fl. oz.

24
Rejuvi "n" Night Cream
1.76 oz.

25
Rejuvi "n" Night Cream (for dry skin)
1.76 oz.

26
Rejuvi "n" Bio Rejuvenating Complex
1 oz.

27
Rejuvi "o" Cleansing Milk
7.04 oz.

28
Rejuvi "p" Normalizing Cream
0.5 oz.

29
Rejuvi "p" Normalizing Cream ( for open acne skin)
0.5 oz.

30
Rejuvi "p" Solution for Acne Skin (enhacned)
10 ml.

31
Rejuvi "p" Skin Conditioner
1 oz.

32
Rejuvi "q" Flavonoid Complex
1 oz.

33
Rejuvi "r" Skin Refreshener
7.04 oz.

34
Rejuvi "r" Clearing Toner
3.4 oz.

35
Rejuvi "s" Sunscreen (SPF 40)
4 oz.

36
Rejuvi "s" Facial Sun Block (SPF40)
2.3 oz.

37
Rejuvi "s" Facial Sun Block (SPF 40) Tinted (skin color)
2.3 oz.

38
Rejuvi "s" Tanning Lotion
3.4 oz.

39
Rejuvi "t" Bio -Firming Gel
1 oz.

40
Rejuvi "u" Wild Yam Cream
1.76 oz.

41
Rejuvi "v" Nourishing Cream
1.76 oz.

42
Rejuvi "w" Skin Whitening Cream
1 oz.

43
Rejuvi "w" Whitening Toner
3.4 oz.

44
Rejuvi "w" Lightening Serum
1 oz.

45
Rejuvi "x" -Cell Vitamin C Complex
1 oz.

46
Rejuvi "y" Light Moisturizer
1.76 oz.

47
Rejuvi "y" Renewal Gel (with EGF)
1 oz.

48
Rejuvi "z" Intensive Contour Gel
4 oz.

49
Rejuvi "z" Contour Cream
4 oz.

50
Rejuvi "z" Facial Contour Serum
1 oz.

51
Rejuvi Purifying Mask
2 .3 oz.

52
Rejuvi Herbal Mask (in Jar)
2 .3 oz.

53
Rejuvi Bio Mask
2 .3 oz.

54
Rejuvi Hydrating Mask
2 .3 oz.

55
Rejuvi Exfoliating Mask
2 .3 oz.

56
Rejuvi Facial Firming Mask
2 .3 oz.

57
Rejuvi Eye Makeup Remover
4 oz.

58
Rejuvi Sani-clean
8 oz.

59
Rejuvi Feminine Wash
7.04 oz.

60
Rejuvi Scarcare Gel
0.5 oz.

61
Rejuvi Redaway (to diminish skin redness)
0.5 oz.

62
Rejuvi Foot Repair Cream
2 oz.

63
Rejuvi Neck Rejuventaion Set
2x1.76 oz

64
Rejuvi Retardant Gel for unwanted femal facial hair
1 oz.

65
Rejuvi Disinfectant (anti-virus)
4 fl. oz.

66
HAIR CARE PRODUCT

67
Rejuville Hair Tonic
2 fl. oz.

68
Rejuville Maintenance
3 oz.

69
Rejuville Shampoo
12 oz

70
Rejuville Anti-Dandruff Shampoo
12 oz.

71
Rejuville Hair Conditioner
12 oz.

72
Rejuville Hair Revitalizer
1 fl. oz.

73
Rejuville Solution for Ingrown Hair
1.76 oz.

74
Rejuville Eyelash Revitalizer
3.5 ml

REJUVI PLUS

76
Rejuvi + Bio Refining Complex
1 oz.

77
Rejuvi + Vital Protection Day Cream
1 oz.

78
Rejuvi + Nightly Renewal Cream
1 oz.

79
Rejuvi + Nightly Renewal Cream (for dry skin)
1 oz.

80
Rejuvi + Essential Serum
1 oz.

81
Rejuvi + Gentle Purifying Emulsion
6.76 oz.

82
Rejuvi + Essential Cleansing Gel
6.76 oz.

83
Rejuvi + Activated Facial Wash
6.76 oz.

84
Rejuvi + Revitalizing Tonic
6.76 oz.

85
Rejuvi + Natural Soothing Gel
6.7 oz.

MERCHANDISE TOTAL:

California sales tax (9.75%) if applicable

Grand Total

Add 9.75% sale tax for California orders and the shipping cost depending upon the geographic location. We use regular airmail for overseas and UPS for U.S.A., unless otherwise specified.

$50.00 minimum order required

Payment option:

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Card Number

Expiration Date

Cardholder name

CVV Number (3 or 4 digit number on back of your card)

You may print this form and mail to: Rejuvi Laboratory Inc.
360 Swift Avenue Suite 38, South San Francisco, CA 94080, USA

Or, fax to (650)588-7796

Or, hit the Send button to send info directly to Rejuvi Lab! (not encrypted).

THANK YOU FOR YOUR ORDER

Name *		Date:
Shipping address *
City *	State/Province *	Zip/Postal code *
Country	Phone
e-mail *

#	PRODUCT	SIZE	$/UNIT	QTY.	AMOUNT
1	Rejuvi "a" Night Gel	1.5 oz.
2	Rejuvi "a" Renewal Complex	1 oz.
3	Rejuvi "a" Retinyl Serum	1 oz.
4	Rejuvi "a" Asta Enhancing Serum	0.5 oz.
5	Rejuvi "b" Skin Moisturizer	1.76 oz
6	Rejuvi "b" Moisturizer Lotion	3.4 oz.
7	Rejuvi "c" Skin Care Formula	1 oz.
8	Rejuvi "d" Clearing Gel	10 ml.
9	Rejuvi "e" Eyebrow Revitalizer	9 ml.
10	Rejvui "e" Eyelash Revitalizer	9 ml.
11	Rejuvi "f" Facial Wash	7.04 oz.
12	Rejuvi "g" AHA Cream	1.76 oz.
13	Rejuvi "g" AHA Cream (for sensitive skin)	1.76 oz.
14	Rejuvi "g" AHA Serum	1 oz.
15	Rejuvi "h" Super Soothing Cream	0.35 oz.
16	Rejuvi "h" Super Soothing Lotion	3.4 oz.
17	Rejuvi "h" Skin Healing Gel	5.1 oz.
18	Rejuvi "i" Eye Repair Gel	1 oz.
19	Rejuvi "i" Eye Repair Cream	2 oz
20	Rejvui "j" Shower Cream	12 oz
21	Rejuvi "k" Facial Cleanser	7.04 oz.
22	Rejuvi "L" Body Lotion	8.38 oz.
23	Rejuvi "m" Massage Oil	4 fl. oz.
24	Rejuvi "n" Night Cream	1.76 oz.
25	Rejuvi "n" Night Cream (for dry skin)	1.76 oz.
26	Rejuvi "n" Bio Rejuvenating Complex	1 oz.
27	Rejuvi "o" Cleansing Milk	7.04 oz.
28	Rejuvi "p" Normalizing Cream	0.5 oz.
29	Rejuvi "p" Normalizing Cream ( for open acne skin)	0.5 oz.
30	Rejuvi "p" Solution for Acne Skin (enhacned)	10 ml.
31	Rejuvi "p" Skin Conditioner	1 oz.
32	Rejuvi "q" Flavonoid Complex	1 oz.
33	Rejuvi "r" Skin Refreshener	7.04 oz.
34	Rejuvi "r" Clearing Toner	3.4 oz.
35	Rejuvi "s" Sunscreen (SPF 40)	4 oz.
36	Rejuvi "s" Facial Sun Block (SPF40)	2.3 oz.
37	Rejuvi "s" Facial Sun Block (SPF 40) Tinted (skin color)	2.3 oz.
38	Rejuvi "s" Tanning Lotion	3.4 oz.
39	Rejuvi "t" Bio -Firming Gel	1 oz.
40	Rejuvi "u" Wild Yam Cream	1.76 oz.
41	Rejuvi "v" Nourishing Cream	1.76 oz.
42	Rejuvi "w" Skin Whitening Cream	1 oz.
43	Rejuvi "w" Whitening Toner	3.4 oz.
44	Rejuvi "w" Lightening Serum	1 oz.
45	Rejuvi "x" -Cell Vitamin C Complex	1 oz.
46	Rejuvi "y" Light Moisturizer	1.76 oz.
47	Rejuvi "y" Renewal Gel (with EGF)	1 oz.
48	Rejuvi "z" Intensive Contour Gel	4 oz.
49	Rejuvi "z" Contour Cream	4 oz.
50	Rejuvi "z" Facial Contour Serum	1 oz.
51	Rejuvi Purifying Mask	2 .3 oz.
52	Rejuvi Herbal Mask (in Jar)	2 .3 oz.
53	Rejuvi Bio Mask	2 .3 oz.
54	Rejuvi Hydrating Mask	2 .3 oz.
55	Rejuvi Exfoliating Mask	2 .3 oz.
56	Rejuvi Facial Firming Mask	2 .3 oz.
57	Rejuvi Eye Makeup Remover	4 oz.
58	Rejuvi Sani-clean	8 oz.
59	Rejuvi Feminine Wash	7.04 oz.
60	Rejuvi Scarcare Gel	0.5 oz.
61	Rejuvi Redaway (to diminish skin redness)	0.5 oz.
62	Rejuvi Foot Repair Cream	2 oz.
63	Rejuvi Neck Rejuventaion Set	2x1.76 oz
64	Rejuvi Retardant Gel for unwanted femal facial hair	1 oz.
65	Rejuvi Disinfectant (anti-virus)	4 fl. oz.

66	HAIR CARE PRODUCT
67	Rejuville Hair Tonic	2 fl. oz.
68	Rejuville Maintenance	3 oz.
69	Rejuville Shampoo	12 oz
70	Rejuville Anti-Dandruff Shampoo	12 oz.
71	Rejuville Hair Conditioner	12 oz.
72	Rejuville Hair Revitalizer	1 fl. oz.
73	Rejuville Solution for Ingrown Hair	1.76 oz.
74	Rejuville Eyelash Revitalizer	3.5 ml

	REJUVI PLUS
76	Rejuvi + Bio Refining Complex	1 oz.
77	Rejuvi + Vital Protection Day Cream	1 oz.
78	Rejuvi + Nightly Renewal Cream	1 oz.
79	Rejuvi + Nightly Renewal Cream (for dry skin)	1 oz.
80	Rejuvi + Essential Serum	1 oz.
81	Rejuvi + Gentle Purifying Emulsion	6.76 oz.
82	Rejuvi + Essential Cleansing Gel	6.76 oz.
83	Rejuvi + Activated Facial Wash	6.76 oz.
84	Rejuvi + Revitalizing Tonic	6.76 oz.
85	Rejuvi + Natural Soothing Gel	6.7 oz.

		MERCHANDISE TOTAL:
California sales tax (9.75%) if applicable
Grand Total