Butt Enlargement Mail Order Form

Glutimax Mail Order Form

We conveniently accept all forms of payment including checks, money orders, PayPal, etc. Personal checks normally take up to 2 weeks to clear. Send a cashier's check or money order for faster turn-around time. Make all payments payable to: CleavOnline. You can also mail us your credit card information if you prefer not using it online...

Complete All Information, Print Form, Then Mail This Form To:

Glutimax.Com
1980 Edgemere Drive
Rochester, NY  14612

Shipping Information

First and Last Name:

Shipping Address:
Including complete 
street address, city, 
state and zip code.

Phone Number:

E-Mail Address:

Credit Card Information (If Paying By Credit/Debit Card)

Visa/MasterCard/Amex/Discover#:

Visa/MasterCard/Amex/Discover Expiration Date:

Product Description
Glutimax - 1 Jar $39.99 + $9.95 S&H Check:
Glutimax - 2 Jars $74.99 + $9.95 S&H Check:
Glutimax - 3 Jars $104.99 + $9.95 S&H Check:
Glutimax - 4 Jars $129.99 + $9.95 S&H Check:
Glutimax - 5 + 1 FREE $149.99 + $9.95 S&H Check:

Shipping Prices
   Upgrade to OverNight S&H (USA Only) +$20 Extra
   NON USA Order +$20 Int'l S&H

Total Cost (USD)

Non USA Orders: Add $20 for International S&H.

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Glutimax butt cream is manufactured and labeled in accordance with strict FDA guidelines and procedures. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. RESULTS MAY VARY.