< Natural Sexual Enhancement | Allurex

Credit Card Billing Information:
*First Name:
*Last Name:
*Email:
*Address 1:
Address 2:
*City:
*State / Province:
*ZIP / Postal Code:
Country:
*Phone:
Fax:
Shipping Address if different from above:
Ship To:
Address
City:
State / Province:
ZIP / Postal Code:

ALLUREX NEW - IMPROVED (MSRP $59.95)	Use Drop Down to Select Quantity
Promotional Code:
Shipping Method Use Drop Down to Select Shipping Method
Method of Payment
American Express \| Visa \| Master Card \| Discover
Total Amount
Exact Name
Credit Card Number
CVV Code
Expiration Date	mm/yy
How did you here about Allurex?


The Allurex Guarantee Allurex is so confident that you will be completely satisfied with your purchase, it comes with a money-back guarantee. If for any reason you are not satisfied with the results, contact us within 15 days of delivery for instructions on how to return the unused portion for a full refund of the purchase price. Shipping and handling charges are nonrefundable and we do not reimburse postage for returning products. We recommend sending packages UPS or insured Parcel Post.
If you have any problems with this form please email to: info@allurex.com

	Harder Longer Lasting Erections!
	Increased Sensation!
	Increase Sex Drive!
	More Energy!
	More Intense Orgasms!
	Best Over All Sex!

To place your order by telephone:

Call: 800-785-1482

or

Fax completed order form to:

702-974-1060

To place your order by Mail:

Print and mail completed order form along with check or credit card information to:

Westport Group, Inc.
P. O. Box 531518
Henderson, NV 89053

Credit Card Billing Information: