Magna RX Store - FAX Order Form

Magna RX+ developed by Dr. Aguilar, a leading medical doctor and urologist, each MAGNA-RX+ tablet contains a unique, high performance male enhancement supplement designed to supercharge your sex life! With millions sold over the past two and a half years, MAGNA-RX+ is currently the world’s #1 best-selling male supplement, and still growing!

Magna RX Inc. Terms

Fax Order Form

Print this form.
You are ordering 2 Bottles of Magna-RX+. The Ultimate Male Enhancement Supplement (60 day supply). Plus you're getting a FREE tube of Magna RX Transdermal Topical Lotion (1 month supply).
U.S. orders $69.90 ($59.95 + $9.95 Shipping and Handling)
Non-U.S. orders $79.90($59.95 + $19.95 Shipping and Handling)
Fill in all of the fields with your information.
We accept cashier's check, money order, credit card or U.S. money only.
Fax this form to: 818-991-0462.

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Billing / Shipping Information

* Full Name:

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* Address:

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* Phone Number:

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Payment Information

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Quantity:

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Signature:

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Finding Your CVV2 Code


	Amex Requirements Card Identification # REQUIRED 4 digit, non-embossed number printed above your account number on the face of your card. This number is recorded as an additional security precaution.		Visa Requirements Card Identification # 3-digit, non-embossed number printed on the signature panel on the back of the card immediately following the Visa card account number. This number is recorded as an additional security precaution.		MasterCard Requirements Card Identification # 3-digit, non-embossed number printed on the signature panel on the back of the card.. This number is recorded as an additional security precaution.

© 2008 Magna RX Inc.
MAGNA-RX+® is a Registered Trademark. All Rights Reserved. Individual results may vary. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.