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1656 N 15th Ave, Tucson, AZ 85705
Toll Free Fax: 1- 866-211-3009 Direct Phone: 520-622-1894
Please fax this order form to the number listed above. Form must be filled out completely and signed. Orders may take 1 day to 5 days to ship based on product availability. No
returns are accepted due to health and perishable issues.
Credit Card Billing Information Payment Method
Name:
Address: Credit Card # : _______________________________________________________________
Address: Name printed on Card: _______________________________________________________________
City, State, Zip Code: Exp. Date: Month / Year: _______________________________________________________________
Day Phone: Card Security Code : _______________________________________________________________
eMail:
Shipping Instructions:
Shipping Address (if different from billing)
Name: Standard Overnight Express Saver
Address: 2ndDay Delivery International
Address: Free shipping FedEx Express Saver with $200.00 minimum order
City, State, Zip Code: Delivery costs may vary according to weight and destination and will be charged to your credit card.
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Item Number Cosmetic Theraphy Devices Price Quantity Total
CDT 01 CARBOSSI - EVOLUTION Carbon Dioxide Therapy System & Advanced Training $
CDT FOOT PEDAL SWITCH - For Carbossi, ITY (1 Yr. Warranty) $ 139.00
CDT RG REGULATOR GAUGE SET - C02 Gas $ 150.00
CDT ITL 10 PK INFUSION TUBES - w/ 0.2um Filters Extension Line (Made in Italy) $ 90.00
CDT USA INFUSION TUBES - 1 each No Filters (Made in USA) $ 2.00
CDT 13 SMALL INFUSION FILTERS -1/Patient (Made in USA) $ 4.00
CDT 50 1 LARGE 50 FILTER - Acro 50 PTFE $ 29.00
CDT K KEY WRENCH - For C02 Gas Cylinder $ 5.00
CDT C CYLINDER STAND - For C02 Gas Cylinder $ 49.00
REGENESIS Q45TS PROFESSIONAL PLATFORM - Includes Arm with 3,840 L.E.D. $ 16,900.00
MC001 PORTA-PEEL MICRODERMABRATOR SYSTEM $ 4,300.00
MC002 MICRODERMABRATOR DIAMOND TIPS $ 750.00
MC C MICRODERMABRATOR AUXILARY CELLULITE - Smooth Kit $ 800.00
MC H MICRODERMABRATOR AUXILARY HYDRO KIT - Per Kit $ 450.00
Dermal Fillers
F01 REVANESSE - Purest Crosslinked Hyaluronic Acid Gel - 1cc Syringe $ 139.00
F02 REVANESSE PURE - Pure Hyaluronic Acid 1cc Syringe New Item Special Offer $ 150.00
F03 REVANESSE ULTRA - Purest Crosslinked Hyaluronic Acid Gel - 1cc Syringe $ 169.00
F04 REVANESSE LIPS - Cross Linked Hyaluronic Acid 25mg/ml - 1cc Syringe New Item $ 150.00
F05 REDEXIS - Cross Linked Hyaluronic Acid Gel w/ Dextranssomere, Sephadex - 1cc Syringe $ 225.00
F06 REDEXIS ULTRA - Cross Linked Hyaluronic Acid Gel w/ Dextranssomere, Sephadex - 1cc Syringe $ 250.00
F07 ANTI WRINKLE SERUM - LINURASE 30ml 1 FL. OZ. Non Toxic, Relaxes Muscles Special Offer $ 70.00
F08 VITAMIN C-erum 30ml 1 FL. OZ. - Dermal Repair Serum $ 75.00
Aptos Threads and Diamond Wire
THR4C APTOS CLEAR THREADS - Pack of 4 Threads $ 149.00
THR6C APTOS CLEAR THREADS - Pack of 6 Threads $ 220.00
SHLT SILHOULETTE LIFT 2 x 25 cm W/Cones New Item Special Offer $ 236.00
THR-STS SOFT TENSOR SHORT $ 115.00
THR-STL SOFT TENSOR LONG $ 130.00
DW01 DIAMOND WIRE - Wire Scalpel Single Needle $ 75.00
DW02 DIAMOND WIRE - Wire Scalpel (Graivier) Double Needle $ 90.00
AN001 APTOS AUTOCLAVABLE NEEDLES - Pkg of 5 (1 Straight, 3 Curved, 1 Punch) $ 450.00
Meso Therapy Supplies
MGUN PROGRAMABLE POWER INJECTION AUTO MESO GUN $
M1:090 ALPHA LIPOIC ACID 2.5% pH 9 - 10ml $ 25.00
M1:101 ARGIRELINE 1% pH 7.0 CSP - 10ml *Not In Stock* $ 29.00
M1:012 ARTICHOKE 2% - 5ml x 10 $ 20.00
M1:092 ASIAN CENTELLA 5.0% pH 7 - 10ml $ 18.00
M1:017 BIOTINE (Vitamin B) - 2ml x 10 $ 29.00
M1:016 BUFLOMEDIL 25 mg - 5ml x 10 $ 29.00
M1:067 CAFFEINE 20% - 2ml x 10 $ 30.00
M: 107 CHROME GLYCEROL 40mg 1% - 5ml x 10 $ 29.00
M1:022 DEX PANTHENOL 20% - 5ml x 10 $ 25.00
M1:088 DMAE 5% pH 7.0 - 10ml $ 35.00
M1:007 GINKGO BILOBA 2ml x 10 $ 19.00
M1:027 GLYCOLIC ACID 1% pH 5.5 - 2ml x 10 $ 45.00
M1:094 HYALURONIC ACID 1.4% pH 6.5 - 10ml *Not In Stock* $ 50.00
M1:028 HYALURONIC ACID 3.5% - 10ml $ 150.00
M1:077 HYALURONIDASE 100 U pH 7.0 - 10ml *Not In Stock* $ 40.00
M: 075 HYALURONIDASE 1500 U Powder - 10ml $ 40.00
M1:030 L-CARNITINE 1g - 5ml x 10 $ 50.00
M1:059 LAURETH-9 (Polidocanol) 2% - 2ml x 10 New Item Special Offer $ 20.00
M1:063 MINOXIDIL 0.5% pH 6.5 - 2ml x 10 $ 60.00
M1:069 MINOXIDIL 0.5% pH 6.5 - 10ml $ 21.00
M1:040 MELILOTUS RUTIN EXTRACT - 2ml x 10 $ 25.00
M1:105 ORGANIC SILICA (Conjoctyl) 0.5% - 5ml x 10 $ 21.00
M1:108 OLIGO ELEMENTS (Selenium, Copper and Zinc) - 5ml x 10 $ 25.00
M1:035 PHOSPHATIDYLCHOLINE 6% - 5ml x 10 Pure Form! No odor or stinging! $ 90.00
M1:080 PHOSPHATIDYLCHOLINE 5% Ph 7.0 -10ml *Not In Stock* $ 30.00
M1:036 SODIUM PYRUVATE 1% - 2ml x 10 $ 50.00
M1:038 PROCAINE 2% - 50ml Vial $ 45.00
M1:083 PROCAINE HCL 2% - 5ml x 10 $ 45.00
M1:055 RETINOIC ACID 1% pH 5.0 - 1ml x 10 $ 45.00
M1:051 VITAMIN C 20% pH 5.8 - 5ml X 10 $ 25.00
M1:056 X-ADENAL - 2ml X 10 $ 99.00
M1:112 X-DNA 3% Highly Polymerized Gel - 2.5ml $ 29.00
M1:004 YOHIMBINE 0.2% - 5ml x 10 $ 22.00
Meso Cocktails
MC:001 LYPOLESS WEIGHT LOSS KIT - 5ml x 10 Vials New Item Special Offer $ 130.00
MC:004 ANTI HAIR LOSS KIT - 5ml x 10 Vials New Item Special Offer $ 130.00
MC:006 SKIN FACIAL REJUVENATION KIT - 5ml x 10 Vials New Item Special Offer $ 130.00
Supplies
BC BETACAINE ® Enhanced Gel - Contents Lidocaine 5% Tube 30g $ 39.00
DLASH DABALASH - Eyelash Enhancer *For Export Only* $ 129.00
S 50 SALINE 0.9% - Sodium Chloride 4 x 50ml $ 10.00
S 250 SALINE 0.9% - Sodium Chloride 250ml $ 3.00
S1000 SALINE 0.9% - Sodium Chloride 1000ml $ 5.00
SU MICROCYN 240ml - Sterile Solution & Antiseptic $ 30.00
SU MICROCYN 5 Lt - Sterile Solution & Antiseptic Special Offer $ 99.00
N 4 30G / 0.30 x 4mm - Carbossi & Meso Needle Box of 100 $ 40.00
N 6 30G / 0.30 x 6mm - Mesotherapy Needle Box of 100 $ 40.00
N 18 18G x 1" DRAW NEEDLES - Box of 100 $ 15.00
N 27 27G X 1.5" NEEDLES - Mesotherapy Infiltration Needle Box of 100 $ 29.00
N 30 30G X 1/2" x 13mm - BD Mesotherapy Needle Box of 100 $ 39.00
N 31 31G x 1/2" NEEDLES - Box of 100 $ 39.00
N 32 32G x 1/2" NEEDLES - Box of 100 $ 44.00
S 1 1cc SYRINGE(S) - Single Use Call for box discount $ 1.00
S 3 3cc SYRINGE(S) - Single use Call for box discount $ 1.00
S 5 5cc SYRINGE(S) - Single use Call for box discount $ 1.00
S 10 10cc SYRINGE(S) - Single Use Call for box discount $ 1.00
Vitamins and Supplements
V-S NATURAL WEIGHT LOSS TABLETS - 60 tablets Bottle Call for box discount $ 69.00
SHP FedEx - Shipping & Handling; Varies Depending on Size, Weight, & Zip Code $ 69.00
DIS DISCOUNT - NuTec International Sales Promotion Discount $
Grand Total $
Products are sterile, suitable for topical use and/or intra dermal injection and sold to medical professionals only. Products are intended as weight loss or inch loss supplements and/or nutritional
supplements. Clinician understands these products are not regulated by the FDA. Physician assumes all risks and liabilities when using these products. Training on use of these products can be arranged
with independent professional trainers. Please call if you are interested in recommendations.
Prices subject to change.
I agree to purchase these items, have my credit card charged for the amount of the products plus shipping. I have read the terms and agreement page of NuTec International including the return policy.
I understand and agree with the policies.
X__________________________________
Our return policy can be located at www.NuTecInt.com
www.nutecint.com sales@nutecint.com
