Washington Institute of Natural Medicine
Arbonne Skin Care Order form
______Acne Spot Treatment – Acne Medication - $22
High performance acne treatment used to clear existing breakouts and prevent new blemishes. Active ingredient: 2% Salicylic acid, Key ingredients: rosa roxburghii fruit extract, lycium barbarum fruit extract
______Lip Saver Sunscreen SPF 30 - $9
Provides high protection for your lips while moisturizing and soothing.
Key Ingredients: safflower seed oil, chamomile extract, and vitamin E
______Tea Tree Oil Shampoo - $27
Cleanses and minimizes dry scalp and helps hair shine.
Key ingredients: vitasheres, tea tree oil, rosemary extract and sage extract.
______Scalp Revitalizer & Thermal Hair Fusion - $26
Helps reverse the action of hair loss in women and men. Promotes beautiful looking hair.
Key ingredients: vitasaphires, horsetail extract, yucca extract, vitamins A, C, and E.
______Muscle Massage Pain Relieving Gel – Herbal - $16
Heats and soothes tired muscles and helps provide temporary penetrating pain relief of minor muscle aches and pains.
Key ingredients: menthol and eucalyptus
______Corrective Eye Cream - $55
Supports collagen to help reduce appearance of puffiness and dark circles.
Key ingredients: algae extract, marine lavender extract, alfalfa seed extract, hydrolyzed lupine protein.
______Skin Conditioning Oil - $14
Helps treat severely dry skin. Helps alleviate the symptoms of eczema, shingles, scaring and sever burns.
Key ingredients: avocado oil jojoba oil, olive oil, vitamins A and E
** All products have a 45-day money back guarantee.
Client Information:
Name: ______(Last)______(First) Date of birth:______
Phone number: ______(Daytime/ Cell)______(Evening)
Mailing Address ______(Street)
______(City) _____ (State) ______(Postal code)
Email Address: ______
Credit Card Information:
Name on Credit Card: ______
Type of Credit card:______Credit card Number:______Expiration Date______Billing Zip Code:______
Shipping Rates: Choose one below
Product order total / UPS Ground / UPS 3rd Day Air$0-$99.99 / $7.95 / $14.95
$100 - $299.99 / $9.95 / $21.95
$ 300 - $399.99 / $12.95 / $28.95
Product total: $ ______+ Sales Tax______+ Shipping ______= Order total $______
(depending on state shipped to)
Thank you