ONLINE ORDER FORM

You may use this online form to place an order directly with Perfect Balance. Alternately, you may go to the "forms" page and

print a form to fax or mail.

If you have ordered from us previously and have payment arrangements on file, billing will take place on the usual terms.

If you have not ordered from us previously you must call (425) 803-0677 to make payment arrangements via check, credit card or PayPal.  Your order will not be processed until you have contacted us at that number.

All orders are shipped via UPS unless the order is shipped to a P.O. Box. See "Shipping Price Breakdown" for shipping cost..

Your Name (required):  
Distributor Business Name (if applicable):  
Email Address (required):  
Daytime Telephone (required):  
( )
Shipping Name (required):  
Shipping Street Address (required):  
Shipping City, State & Zip (required):  
Shipping Speed Preference (required):
Ground    2nd Day    3rd Day    Next Day
Have you ordered from us before? (required)
 Yes No If "no", you must call (425) 803-0677 before we can process your order
If we have a credit card for you on file, is the expiration date still valid? (required)
 Yes No If no, what is the new expiration date?
Do you work with a Perfect Balance Distributor? (required)
 Yes No If yes, what is the name of the individual or business?
   
PLEASE SELECT THE

(LEAVE THE BOX BLANK

NUMBER OF EACH PRODUCT DESIRED.

IF YOU ARE NOT ORDERING THAT PRODUCT)
Adjunct: 
Ancer: 
AminoSculpt: 
Apricot Kernels:  
Balsamea: 
Estor:  
Excel:  
Excitor:  
Hemestor:  
Hi-Q:  
Hydrade:  
Hydralev:  
Impact:  
Inner-G  
Perfect Balance:  
pHenomenal:  
React:  
Orasal:  
Stable:  
Sterling:  
Support:  
Vitamin C:  
Vitamin E-400:  
1918:  
Another Product (if not listed):  
Hair Analysis Sample Kit: