LipSense Sample Form

LipSense Order Form
After you fill out this request, I will send you a PayPal invoice confirming your order and requesting payment. Your order will not be completed until payment has been received. Thank you for ordering and I know you're going to look fabulous in your LipSense!
Are you a new or existing customer?*

I am a new customerI am an existing customer
What is the item you would like to order?*
Please enter the item, description, and quantity (example Lip Kit with Bella (2) or ShadowSense in Pink Frost (1) )
Contact Info
Your Name*

First NameLast Name
Contact Number*
E-mail*
We will send your Paypal invoice to this email address.
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Are you an Active Senegence Distributor?*

YesNo
If you are an Active Senegence Distributor, is this order for your personal use only?*

Yes, these products are for my personal use only.No, these are for resale to customers.I am not an active distributor.
Additional Requests/Comments
Should be Empty:

LipSense Order Form