Resellers

Pricing information is available here. This online form below may also be used for bulk orders. Bulk pricing will be calculated automatically for purchases of 10+ units.

How to Use This Payment Form

Fill out all required (*) information.
Fill out additional shipping information if necessary.
Your charge will be automatically calculated for you.
Click "Confirm Order" to see final payment details before being redirected to our secure payment gateway.

If you have any questions please Contact Us for assistance.

Product Information

Twin Pack

Quantity: *

Choose Twin Pack Contents:

Starter Kit: 1 Regular FemmyCycle, 1 Low Cervix FemmyCycle 2 Regular FemmyCycles 2 Low Cervix FemmyCycles 2 Teen FemmyCycles 1 Regular FemmyCycle, 1 Teen FemmyCycle

Unit Price: Twin Pack Subtotal:

Single Pack

Quantity: * Choose Single Pack Contents:

1 Regular FemmyCycle 1 Low Cervix FemmyCycle 1 Teen FemmyCycle

Unit Price: Single Pack Subtotal:

Billing Information First Name *
Last Name *
Address Line 1 *
Address Line 2
Country *
State/Province *
City *
ZIP/Postal Code *

Phone Number *
Fax Number
Email Address *

Shipping Information

Standard Shipping

Destination

Ship to Billing Address
Ship to Another Location:

If you are a California reseller, please enter your seller's permit number:

Please don't forget to fax your resale certificate to (858) 792-2624

Subtotal
Shipping
Sales tax (California residents only)
Total

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