Benev - Cosmeceuticals - Customer Order Form v040122
Benev – Cosmeceuticals – Customer Order Form v04122
Orders may be Faxed: 972-250-0104 or Emailed: email@example.com
The sale of these items may be subject to regulation by the U.S. Food and Drug Administration and state and local regulatory agencies. If so, do not purchase these cosmeceuticals unless you are an authorized purchaser. If the item is subject to FDA regulation, we will verify your status as an authorized purchaser of this item before shipping of the item. Required information to Order: Medical License Number (Required), Medical License Owner Name (Required).