Crescenew Order Reservation Form

REQUEST to HOLD or SHIP
(This is NOT an actual order unless you have already paid via PayPal.)

CRESCENEW Pricing for Individual Orders
One 250ml Bottle	Current Price $18.00 (Regularly $20.00 each)
Two 250ml Bottles	Current Price $16.00 (Regularly $19.00 each)
Three 250ml Bottles	Current Price $15.00 (Regularly $18.00 each)
Please add $4.95 for Shipping & Handling to your order
Please send your paid order to: Horizon Telemedia Attn: Crescenew 254 Park Ave South, 3rd Floor New York, NY 10010-7209 (If already paid via PayPal, do not send order by post.)

If you have not just sent payment via PayPal, you may do so BEFORE filling in this form by using the PayPal Button for fastest shipping.
Choose One, Please:
I have already paid via PayPal
I will mail payment
This is an Inquiry or Correction

CRESCENEW Pricing for Individual Orders

One 250ml Bottle Current Price $18.00
(Regularly $20.00 each)

Two 250ml Bottles Current Price $16.00
(Regularly $19.00 each)

Three 250ml Bottles Current Price $15.00
(Regularly $18.00 each)

Please add $4.95 for Shipping & Handling to your order

Please send your paid order to:

Horizon Telemedia
Attn: Crescenew
254 Park Ave South, 3rd Floor
New York, NY 10010-7209

(If already paid via PayPal, do not send order by post.)

Please note our email for future reference
crescenew-usa@horizontm.com

Please fill in all possible fields below. Your order will be held until payment and confirmation has been received. If we can not supply you at this time, we will respond to the email you give below. Any payment received will result in shipment immediately, or as soon as inventory has been replaced. (Sometimes it helps to use the telephone to sort out priorities when inventory becomes low. Complete information below will improve our ability to serve you.)

Your information will not be shared with anyone!

Please reserve Zero One Two Three unit(s) for me I will add Shipping and Handling of $4.95 (USA/Candada)
Your Email Address	(CAREFUL! If this is wrong, we can't respond.)
Your Name
Your Mailing Address
Contact Telephone	(We use this to track your order)
Alternate or Message Telephone
What categories do you or the intended user(s) fit in? (check all that apply!)	Losing hair MPB (male pattern baldness) Alopecia Areata Have Seborrhea Hair is chemically treated Hair is dry-heat treated Hair has been straightened Scalp is oily Have flaking
I will order Crescenew	For my personal use For someone else's use
Genetic differences have a role in body chemistry. We would like to track the effectiveness of Crescenew by the ethnic background of its users. Please indicate the most influential components of the product user's ethnic makeup (optional).	Prefer not to say White Black Asian Semitic Peoples Indian Subcontinent N/S Amer Indian Other
Your Questions and Notes

We will let you know if your shipment might be delayed. Please give us a day to respond.

These web pages are created and maintained by Horizon Telemedia which may be reached
in New York at the email link listed above.