Eye Form 1 – gettingbeter.com

FILL THE FORM BELOW TO ORDER

Only Fill this form if you have your money Ready to Buy this Eye Solution

Name *

Phone Number *

Second Phone Number *

State/Local Govt *

Delivery Address *

Treatment Pack *

1 Bottle for 28,500

2 Bottles for 46,000

3 Bottle for 65,000 + 1 FREE Eye Tea (RECOMMENDED Pack)

4 Bottles for #78,500 + 2 FREE Eye Tea (BEST & COMPLETE Pack)

Are You Very Sure You Are Ready to Buy This Product? *

YES I AM

NO I AM NOT

Will You Be Available to Receive This Product in the next 48 Hours? *

YES I WILL

NO I WILL NOT

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