RA Skincare Order Form

REFINED AESTHETICS ORDERING

MEMBER SKINCARE ORDERING FORM
Orders will only be filled once payment is received. Please be sure to indicate how you would like to pay for the items. We have included an area below to confirm which card you would like to use in case you have more than one on file.

Once you orders had been filled, you will receive an emailed reciept and a text to coordinate pickup.

If we have any questions about your order or if any items are not in stock, we will call or text from our business line 605-549-1312.
Name

First NameLast Name
E-mail
example@example.com
Phone Number

Area CodePhone Number
List skincare items you would like to purchase. Please include NAME & SIZE to ensure you receive the correct products.
Kortni
Take a photo of your products and upload it here for easier ordering. Please make sure the name of the product and size are shown in the photo.

Cancelof
How you would you like to pay for your items? Select one of the following

I am a MEMBER: Use my wallet money and the card on file for the remaining balance if my wallet money doesn't cover the entire amount.I am a MEMEBR: Charge my card on file. I want to save my wallet money for treatments.I am NOT A MEMBER: Call to collect payment & tell me about the membership.
Please confirm the last 4 digits of the card on file you'd like us to use.
Signature to submit order & payment.

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REFINED AESTHETICS ORDERING