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  *First/Last Name:
  *Shipping Address:
  *Phone Number:
  Method of Payment:  Visa
 Master Card
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 American Express
  Card Number:
  Card Expiration Date:
  Name that appears on card if different:
  Card Billing Address if Different:
  *What would you like to order?:  Pure Confidence (2 fl. oz.) $5.95
 Pure Comfort (4 fl. oz.) $19.95
 Nourishing Body Bar (5.3 oz.) $4.50
 Nourishing Body Cleanser (7 fl. oz.) $8.75
 Nourishing Body Cleanser (32 fl. oz.) $29.95
 Pump for 32 oz. Nourishing Body Cleanser $1.00
 Replenishing Body Lotion (5.5 fl. oz.) $10.75
 Silk Essence Shampoo (8 fl. oz.) $9.25
 Silk Essence Conditioner (6 fl. oz.) $9.25
  Email Address:
  *First and Last Name of person who referred you: