Pinnacle Point Luvigix- Order Form

Pinnacle Point -Luvigix Order Form

Note: For recurring orders, this process applies once the New Account Form and Credit Card Authorization Form have been completed and the account has been activated. *Please ensure all sections of this order form are completed in full—incomplete forms cannot be processed or fulfilled.
Physician's name as it appears on medical license:

First NameLast Name
Company Legal Name:
Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email (for provider):
Cell Phone (for provider) for verification *not landline for business :
Representative Name:
Representative Email:
Order Quantities:
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ReviveX Starter Pack
x2 Boxes, Free Marketing*

$1,600.00



ReviveX
1-5 Boxes

$800.00 Quantity



ReviveX
6+ Boxes

$785.00 Quantity



Luvigix 1.4T Custom Product
Custom Batch#, Lot#, & COA (Shipping Fee: $175.00, DRY ICE)

$1,000.00 Quantity



Luvigix 3.6T Custom Product
Custom Batch#, Lot#, & COA (Shipping Fee: $175.00, DRY ICE)

$3,250.00 Quantity



Juvasonic Starter Pack w/ ReviveX
1× Juvasonic Device,1×USB-C Charger, 2× Boxes Nano-Chip Cartridges (Empty) – 20 units , 2× Boxes ReviveX – 10 units, 1× Tabletop Marketing Display, 20× Patient Trifolds – Skin, 20× Patient Trifolds – Hair

$4,625.00 Quantity



Juvasonic Device
Includes: 1x Juvasonic Device, 1x USB-C Charger

$2,100.00 Quantity



Juvasonic Device and .2 NanoTips
x1 Juvasonic Device, x2 boxes of Nano Tips

$2,500.00 Quantity



Juvasonic .2 NanoTips
x 10 Nanotips (1 box)

Free Quantity



Patient Trifolds Skin
x20 per bundle, includes shipping

$40.00 Quantity



Patient Trifolds Hair
x20 per bundle, includes shipping

$40.00 Quantity



ReviveX Flat Fee Shipping

$125.00 Quantity



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Pinnacle Point -Luvigix Order Form

Order Quantities:

My Products