*Maria Ramos* BioSkin New Customer Order Form

Customer Name*

First NameLast Name

License #*

Business Name*

Shipping Address-*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is your billing the same as shipping*

What type of address is the ship to: (Please check the appropriate box for UPS)*

Business AddressResidential Address

Billing Address-Enter if different than your shipping

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com (NOTE: INVOICES WILL BE EMAILED TO THIS EMAIL ADDRESS)

ORDER:

Starter Kits

Premium Kit - Blue, Gold, Back Bar Finishing Products & Retail After Care Product Image

Premium Kit - Blue, Gold, Back Bar Finishing Products & Retail After CareBox of BioRePeel Blue, Box of BioRePeel Gold, 8 x Retail BioReLift 1.01 fl oz, 8 x Retail BioReHydra 1.01 fl oz, 1 x Backbar BioReLift 6.76 fl oz 1 x Backbar BioReHydra 6.76 fl oz, 1 x BioCleanser 6.76 fl oz, 10 BioHydra masks x 0.74 fl oz (10 x 22 mL)

$1,917.00 Quantity

Blue Starter Kit A Box of BioRePeel Blue, 5 x Retail BioReLift 1.01 fl oz, 5 x Retail BioReHydra 1.01 fl oz, 1 x BioCleanser 6.76 fl oz, 10 BioHydra masks x 0.74 fl oz (10 x 22 mL)

$948.00 Quantity

Blue Starter Kit B Box of BioRePeel Blue, 5 x Retail BioReLift 1.01 fl oz, 5 x Retail BioReHydra 1.01 fl oz, 1 x Backbar BioReLift 6.76 fl oz 1 x Backbar BioReHydra 6.76 fl oz, 1 x BioCleanser 6.76 fl oz, 10 BioHydra masks x 0.74 fl oz (10 x 22 mL)

$1,188.00 Quantity

Blue Starter Kit CBox of BioRePeel Blue, 1 x Backbar BioReLift 6.76 fl oz 1 x Backbar BioReHydra 6.76 fl oz, 1 x BioCleanser 6.76 fl oz, 10 BioHydra masks x 0.74 fl oz (10 x 22 mL)

$888.00 Quantity

Gold Starter Kit A Box of BioRePeel Gold, 4 x Retail BioReLift, 4 x Retail BioReHydra

$829.00 Quantity

Gold Starter Kit B Box of BioRePeel Gold, 5 x Retail BioReLift 1.01 fl oz, 5 x Retail BioReHydra 1.01 fl oz, 1 x Backbar BioReLift 6.76 fl oz 1 x Backbar BioReHydra 6.76 fl oz

$1,089.00 Quantity

Gold Starter Kit CBox of BioRePeel Gold, 1 x Backbar BioReLift 6.76 fl oz 1 x Backbar BioReHydra 6.76 fl oz

$789.00 Quantity

Lucente

3 MONTH PROGRAMIncludes: 2 x 2.4mL vials of Lucente Serum, 3 Lucente home care cream

$400.00 Quantity

4 MONTH PROGRAMIncludes: 2 x 2.4mL vials of Lucente Serum, 4 Lucente home care cream

$500.00 Quantity

5 MONTH PROGRAMIncludes: 4 x 2.4mL vials of Lucente Serum, 5 Lucente home care cream

$700.00 Quantity

6 MONTH PROGRAMIncludes: 4 x 2.4mL vials of Lucente Serum, 6 Lucente home care cream

$800.00 Quantity

Peels

BioRePeelC13 Gold0.41 fl. Oz per vial x 3 Vials

$549.00 Quantity

BioRePeelC13 Blue(0.21 Fl. Oz x 5 Vials-Face)

$499.00 Quantity

BioRePeelCl3 Rose0.14 fl oz per vial x 3 vials

$200.00 Quantity

Professional Size Products

BioReLift 200 ml

$120.00 Quantity

BioReHydra200 ml

$120.00 Quantity

4 Ever Large Conditioning Kit Product Image

4 Ever Large Conditioning Kit(200 ml)

$300.00 Quantity

BioCleanser6.76 fl oz (200mL)

$50.00 Quantity

BioHydra Masks10 packs x 0.74 fl oz (10 x 22 mL)

$99.00 Quantity

Retail Size Products

BioReLiftQuantity Discounts 3 sets, 5 sets + *Adjust quantity to see discount.

$45.00 Quantity

BioReHydraQuantity Discounts 3 sets, 5 sets + *Adjust quantity to see discount.

$45.00 Quantity

4 Ever Conditioning Kit(50 ml)

$95.00 Quantity

Mesotherapy Serums

AK- Firming Serum(5 vials x 5ml)

$349.00 Quantity

HY- Hydrating Serum(5 vials x 5ml)

$349.00 Quantity

RD- Radiance Serum(5 vials x 5ml)

$349.00 Quantity

HB- Hair Booster Serum(5 vials x 5ml)

$349.00 Quantity

Brochures/Extras

BioRePeelcl3 Brochure Pack 25

$4.99 Quantity

BioRePeelcl3 Spanish Brochure Pack 25

$4.99 Quantity

Mesotherapy Brochure pack 25

$4.99 Quantity

Lucente Brochure pack 25

$4.99 Quantity

BioRePeelcl3 Rose Brochure Pack 25

$4.99 Quantity

Subtotal

$0.00

Shipping

$0.00

Total

$0.00

Do you need update card info*

Call or Email your rep with Credit Card Number this form WILL NOT display your card number.

US CUSTOMERS MUST present Tax Resale certificate in order to have tax WAIVED on order (APPLICABLE TO ALL STATES)

USA Business, do you have tax exemption? type YES or NO and email form to orders@bioskinaesthetics.com failure to send certificate will result in Tax being charged on your order.

US customers ONLY MUST present Tax Resale certificate tohave tax WAIVED on order. IF YOU ARE NOT IN AN APPLICABLE STATE, *DISREGARD*

Failure to send certificate will result in applicable state tax being charged on your order.

Resale Certificate Upload

Should you need an example, please reach out to your BioSkinAccount Manager

ORDER additional request and or notes:

I, First Name* Last Name* hereby acknowledge my understanding that there are no refunds, returns, or exchanges on any Bioskin Aesthetics product, unless otherwise authorized by the Bioskin Aesthetics management, in writing.

I am authorizing this purchase with full knowledge of this policy.

Signature*

Maria Ramos Online Order Form

Additional shipping fees may apply to certain states/countries. Please ask your rep for details.